What if Steroids Don’t Take Effect for FSGS Patients
There was a kidney patient. He was diagnosed with FSGS. After about 70 days’ treatment, his proteinuria was not reduced at all. What if steroids don’t take effect for FSGS patients? Read on to learn more information.
Focal segmental glomerulosclerosis (FSGS) is not a clinical disease but a pathological diagnosis that must be made by renal biopsy. The pathology is characterized by numerous localized glomerular and/or partial glomerular lesions. In general, some glomeruli have developed irreversible necrosis and sclerosis.
FSGS is divided into three categories: primary, secondary and hereditary. Its clinical manifestations include 100% proteinuria of varying degrees and over 60% Nephrotic Syndrome (urinary protein ≥ 3.5g /d). About 50% have hematuria of varying degrees. 1/3 of patients have high blood pressure and renal insufficiency, and manifestations of glomerular function impairment at the onset of the disease.
For persistent Nephrotic Syndrome, if not actively treated, more than 50% of patients will enter the uremia stage within 5-10 years.
Principles of treatment for primary FSGS
- Active symptomatic treatment, including reducing proteinuria, decreasing blood pressure, lowering blood cholesterol, anti-coagulation, anti-thrombosis, nutritional maintenance and support therapy;
- Protecting renal function, preventing or delaying renal function damage and slowing down the progress of the disease;
- Prevention and treatment of complications, including infections, thromboembolic complications, abnormal water and electrolyte metabolism, etc.
- Patients with recurrent Nephrotic Syndrome may consider the combination of glucocorticoids and immunosuppressive drugs.
Immunosuppressant treatment for FSGS
Glucocorticoid therapy can refer to the treatment of minimal change disease, that is, prednisone 1 mg/kg/day, or methylprednisolone 0.8 mg/kg/day, but the duration of maintenance therapy should be prolonged. It is recommended to use 3-4 months as a first-line treatment. If the treatment is ineffective for more than 6 months, it is called glucocorticoid resistance.
The side effects, including infection, elevated blood sugar, gastrointestinal ulcer, gastrointestinal bleeding and calcium loss, should be closely monitored and preventive measures should be taken.
If the therapeutic effect of FSGS using steroids alone is not ideal, it should be combined with immunosuppressant cyclophosphamide or cyclosporine A. Cyclophosphamide is injected intravenously 0.4-0.6 g each time, and the total dose is not more than 0.1-0.15 g/kg every other week. Cyclosporin A is taken 4-5 mg/kg every day, twice on an empty stomach. Slowly reduce dosage after 2-3 months. It can be maintained at a low dose of 3 mg/kg per day for a long time. The dosage lasts for about half a year.
For patients who are ineffective in cyclosporine A treatment, Tacrolimus 0.05-0.1 mg/kg per day and serum trough concentration 5-10 ng/ml can be used.
For patients with glucocorticoid dependence and recurrence, cyclophosphamide, cyclosporine and mycophenolate mofetil (1-2 g/d, 3-6 months) may be beneficial to prolong the duration of remission.
For patients who are ineffective in the above treatment, Rituximab or plasma exchange may be tried.
Treatment suggestions for FSGS patients
The condition of FSGS itself is relatively serious, and the response to various treatments is poor. The disease often presents a chronic progressive process, and chronic renal failure often occurs. According to statistics, the partial and complete remission rate of the disease is only 15% - 40%, and the median time of complete remission for adults is 3 - 4 months.
Your steroid therapy lasts only 70 days, less than 3 months. Please continue to maintain the current steroid dosage and use immunosuppressive therapy. At the same time, ARB antihypertensive drugs are used to reduce blood pressure, decrease urinary protein and delay renal damage.
What if steroids don’ take effect for FSGS patients? Now you get the answer. For more information on FSGS treatment, please leave a message below or contact online doctor.
***Please seek professional medical advise for the diagnosis or treatment of any ailment, disease or medical condition. This article is not intended to be a substitute for the advice of a licensed medical professional.***