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Kidney Health FSGS

A Kidney Disease Mystery: What is FSGS?


Author:

Jai Radhakrishnan, MD, MRCP (UK)

Columbia University College of Physicians and Surgeons

Leonard Stern, MD

College of Physicians and Surgeons of Columbia University

Medically Reviewed On: November 26, 2001

Many cases of kidney disease in the United States are linked to other serious medical conditions like high blood pressure or diabetes. But there are also forms of kidney disease that strike without clear cause, and have serious repercussions. Below, two doctors discuss one such disease, called focal segmental glomerulosclerosis, or FSGS.

What is FSGS?
LEONARD STERN, MD: This illness attacks the glomerulus, or the main filtering part of the kidney. There are two forms of FSGS, and they both cause protein to leak into the urine. Over time, the protein acts as a toxin that injures the remaining parts of the nephrons. The rate of the resulting damage fluctuates from patient to patient. For some it is progressive and slow, in others it is rapid. In any case, the damage leads to kidney failure, which requires dialysis or transplant.

How common is the disease?
JAI RADHAKRISHNAN, MD: If you look at all the diseases that cause kidney failure together, FSGS is not common. But it is one of the most common causes of nephrotic syndrome, or leakage of protein from the kidneys to the urine.

Who is most at risk for developing this disease?
LEONARD STERN, MD: It largely affects males, and affects African Americans more than white Americans. It has some association with illicit drug use and HIV and AIDS, and also it is associated with obesity, urinary tract infections and mechanical reflux of urine from the bladder into the uterus.

Is there a suspected relationship between FSGS and autoimmune disorders?
JAI RADHAKRISHNAN, MD: The word "autoimmune" means that the body produces immunity against itself, and in doing so it damages organs. There's data published in both France and the United States that suggests that in FSGS, a protein or substance in the blood goes and destroys the filters of the kidney, causing it to become more leaky, and it's not yet known what this protein is.

How is FSGS discovered?
JAI RADHAKRISHNAN, MD: FSGS is often first identified by detecting protein in the urine. Equally common is the patient who presents with body swelling because of salt and water retention. Patients are also diagnosed with high blood pressure, and not uncommonly, FSGS can progress without any symptoms, causing kidney failure.

LEONARD STERN, MD: Definitive diagnosis comes from a kidney biopsy where ultrasound is used to find the kidney and do a needle biopsy.

How is FSGS treated?
LEONARD STERN, MD: It's very difficult to treat a patient with kidney disease without actually knowing the type of disease, because we treat them with different medications.

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