Kidney Health

A Kidney Disease Mystery: What is FSGS?

Since we don't understand the primary cause in the vast majority of patients, all we do is treat the features of the illness, and those might be related to the high blood pressure that the illness causes, and we directly attack the protein leaking into the urine.

What sorts of medications are used?
JAI RADHAKRISHNAN, MD: If it's the inflammatory type of disease, we try to suppress the immune system with cortical steroids, a form of hormone that's made by the body, given at high doses.

If that fails or if the patient cannot tolerate this, we have cyclosporine or CellCept. Some people have used a process called plasma exchange where the protein that's abnormal in the blood is removed by a process of purification and then normal plasma is given back.

How effective are these treatments?
JAI RADHAKRISHNAN, MD: About one-half of the patients respond to one or the other kind of treatment. It's also very important to control blood pressure in all patients, because high blood pressure could worsen the prognosis of this disease.

Can this disease be cured?
LEONARD STERN, MD: I don't think the illness could be cured by our present medications, but we can place the patient in what we call a "clinical remission." A responder would be someone whose blood pressure is well controlled and the protein in the urine is eliminated.

When that happens, we hope that the patient can sustain that remission for a long period of time. One of the unknown variables is, how long do we treat the patient? It's the subject of much research, but there are not a lot of answers yet.

In what way should the average patient screen for this condition?
LEONARD STERN, MD: During a normal physical examination, the blood pressure needs to be checked, and at some point an examination of the urine should be done. An ordinary urinalysis will detect protein and inflammatory cells, and that's a superb screening test.

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