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Focal Segmental Glomerulosclerosis Follow-up

  • Author: Sreepada TK Rao, MD, FACP; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jun 06, 2016
 

Further Outpatient Care

Patients receiving long-term corticosteroid therapy must be monitored for prednisone toxicity (eg, infections, hypertension, hyperglycemia). If cyclophosphamide is used, watch for leukopenia and hemorrhagic cystitis. During cyclosporine therapy, monitor renal function. Adjust diuretic doses according to fluid retention. During mycophenolate mofetil therapy, monitor WBC count and liver function. Patients receiving HAART will need periodic determination of viral load to assess the effectiveness of drugs used.[16]

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Complications

Complications of prednisone therapy include the following:

  • Infections
  • Hypertension
  • Hyperglycemia

Complications of cyclophosphamide therapy include the following:

  • Infections
  • Leukopenia
  • Hemorrhagic cystitis

Complications of cyclosporine therapy include the following:

  • Renal insufficiency
  • Gingival hyperplasia
  • Infections
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Prognosis

The natural history of FSGS varies a great deal. A typical course runs from edema that is difficult to manage to proteinuria refractory to corticosteroids[1] and other immunosuppressive agents to worsening hypertension and progressive loss of renal function. Average time from the onset of proteinuria to ESRD is 6-8 years, although wide variations in the time course occur. Prognosis is much worse in blacks compared with whites. In the collapsing form of FSGS, the disease is marked by severe hypertension, more massive proteinuria, poorer response to corticosteroids, and a much faster rate of progression to ESRD.

The level of proteinuria greatly influences the outcome in FSGS. In patients with non-nephritic proteinuria, renal function remains stable and less than 15% progress to ESRD in 10 years. More than 50% of patients with persistent nephritic syndrome develop ESRD in 10 years. In those with massive proteinuria greater than 10-15 g/day, renal functional deterioration is even more rapid (2-3 years).

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Patient Education

Educate patients about renal failure, control of hypertension and lipids, and options for renal replacement therapy, such as peritoneal dialysis, hemodialysis, and renal transplantation. For further information, see Mayo Clinic - Kidney Transplant.

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Contributor Information and Disclosures
Author

Sreepada TK Rao, MD, FACP Professor, Department of Medicine, State University of New York Downstate Medical Center

Sreepada TK Rao, MD, FACP is a member of the following medical societies: American Society of Hypertension, International Society of Nephrology, American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, American Society for Biochemistry and Molecular Biology, American Federation for Medical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, Kentucky Medical Association, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Chike Magnus Nzerue, MD, FACP Professor of Medicine, Associate Dean for Clinical Affairs, Meharry Medical College

Chike Magnus Nzerue, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

Acknowledgements

Anjana S Soman, MD Staff Physician, Department of Pathology, Quest Diagnostics

Anjana S Soman, MD is a member of the following medical societies: American Society for Clinical Pathology and College of American Pathologists

Disclosure: Nothing to disclose.

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