Is FSGS Reversible
Current treatments, particularly renin-angiotensin system inhibition alone, are insufficient to initiate and sustain long-term regression of glomerular structural damage. Potential reversal of glomerulosclerosis involves the mechanisms of matrix remodeling, capillary revascularization, and podocyte remodeling. In the future, treatments will include novel anti-inflammatory and anti-fibrotic molecules with multiple strategies to enhance the reversal of glomerular segmentation sclerosis.
The treatment of focal segmental glomerular sclerosis (FSGS) has been focused on controlling blood pressure and inhibiting the renin angiotensin system, but only leads to slow progression of FSGS. However, the development of treatments over the years has shown the possibility of hardening degeneration, which has led to a paradigm shift in the formation of progressive scarring (sclerosis).
Potential reversal of FSGS
Renal tubular epithelial cells have sufficient regenerative capacity. Thus, parenchyma tissues and their function can be restored after acute kidney injury. Portions of the glomeruli can be restored by capillary lengthening and/or branching. Three-dimensional reconstruction using a single glomerular capillary cluster shows that the space previously occupied by glomerular sclerosis is now occupied by new capillary tissue.
Individual glomerular clusters with FSGS occupying more than 50% of capillaries are destined to progress. In contrast, glomeruli with < 50% sclerotic clusters are able to grow new capillary loop. Not all glomerular cells have the same capacity to regenerate. Although endothelial and mesangial cells proliferate easily after injury, podocytes have limited ability to regenerate.
Mechanism of reversal of FSGS or segmental glomerulosclerosis
Reversal of glomerular sclerosis can occur in a variety of steps, including matrix remodeling, capillary revascularization, and podocyte remodeling. High doses of ACEI or ARB can slow the progression of Chronic Kidney Disease and even partially reverse segmental glomerulosclerosis. However, RAS inhibition alone does not seem to be sufficient to initiate and sustain long-term regression of glomerular structural damage. Future new approaches include considering and targeting additional mechanisms of therapy to optimize matrix remodeling, capillary recombination, and podocyte remodeling. Therefore, in addition to standard RAS inhibition, multiple strategies including novel anti-inflammatory and anti-fibrotic molecules should be considered to enhance the reversal of glomerular stage sclerosis.
Is FSGS reversible? In early stage, it is, so you had better take treatment as early as possible. For more information on FSGS treatment, please leave a message below or contact online doctor.
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