What To Do If Hormone Treatment Is Not Effective For FSGS
One patient consulted that he was diagnosed with Focal Segmental Glomerulonephritis (FSGS) and had taken glucocorticoids for 70 days. But his proteinuria still existed. What to do?
Focal segmental glomerulosclerosis (FSGS) is not a clinical disease but a pathological diagnosis that must be made by renal biopsy. The pathological character shows lesions in many local glomerulus and/or parts of the glomerulus. In general, a portion of the glomeruli has developed irreversible necrosis and sclerosis.
FSGS can be divided into three categories: primary, secondary and hereditary. And the clinical manifestations include that 100% patients have varying degrees of proteinuria and more than 60% of the patients show Nephrotic Syndrome (urine protein quantity ≥3.5g/d); about 50% patients have different levels of blood in urine; about 1/3 patients have high blood pressure, kidney dysfunction and damaged renal tubule function.
For persistent Nephrotic Syndrome, without active treatment, over 50% patients will have uremia within 5-10 years.
Treatment principle of primary FSGS
1. Active symptomatic treatment, including proteinuria, blood pressure, lipid lowering, anticoagulation, antithrombosis, nutritional maintenance and support therapy
2. Protect kidney function, prevent or delay kidney function damage and slow down the progression of kidney disease
3. Prevention and treatment of complications, including infection, thromboembolic complications, abnormal water electrolyte and acid-base metabolism, etc
4. Patients with recurrent nephrotic syndrome may consider combination therapy with glucocorticoid and immunosuppressive drugs.
The glucocorticoid treatment plan can be referred to the treatment plan for Minimal Change Disease. That is, prednisone is 1mg/kg/day or methyprednisolone is 0.8mg/kg/day. But the duration of maintenance treatment should be extended. It is recommended to use 3-4 months as the first line of treatment. If it is useless after taking 6 months of medicines, it is called glucocorticoid resistant. Side effects should also be monitored like infection, elevated blood sugar, peptic ulcers, gastrointestinal bleeding and calcium loss and also be given corresponding preventive treatments.
Hormone therapy alone with FSGS is not ideal and should be combined with immunosuppressant cyclophosphamide or cyclosporine A. Cyclophosphamide is 0.4-0.6g each time and the total dose should not exceed 0.1-0.15g/kg. Cyclosporine A should be taken 4-5 mg/kg twice a day.
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***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.***