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Overview

Glomerulosclerosis, also referred to as focal segmental glomerulosclerosis (FSGS), is a medical condition where scar tissue develops on the glomeruli of the kidneys. These are the parts of the organs where waste products are filtered from the blood.

Types of FSGS

There are three types of FSGS and each one will have different treatment protocols associated with them. They are:

  • Primary FSGS - this type of glomerulosclerosis is also called idiopathic FSGS because healthcare professionals have not found any causes linked to this particular condition.
  • Secondary FSGS - the causes of this subtype of FSGS may include toxicity caused by certain drugs and medications, exposure to infective organisms, sickle cell disease, and diabetes. Managing or controlling the underlying cause of the condition usually stops the ongoing damage to the kidneys and this may even aid in improving renal function over time.
  • Genetic/familial FSGS - as the name suggests, this form of the disease is caused by genetic mutations in the affected individual which are passed onto them from their parents. This is a rare form of glomerulosclerosis of the kidneys.

Symptoms and Signs

In the early stages of the disease, symptoms may not be evident. While patients may experience a particular set of symptoms, their attending physician will also pick up certain signs. These include:

  • Weight gain due to the buildup of fluid in the body because the kidneys cannot excrete this adequately.
  • Increased swelling in areas of the body such as the ankles, lower legs, and around the eyes. This is called oedema.
  • Protein is present in the urine which causes the fluid to have a foamy appearance to it. The damage caused to the kidneys by the scarring allows large molecules such as proteins to pass through the glomeruli. This can also result in lowered protein levels in the bloodstream.
  • Increased fat levels in the blood, also referred to as hypercholesterolaemia.

Complications

One of the complications of FSGS is a condition called nephrotic syndrome which causes a certain set of symptoms and signs to occur. These include:

  • Oedema.
  • Large amounts of protein in the urine.
  • Decreased levels of protein in the bloodstream.
  • High levels of cholesterol in the bloodstream.
  • These issues occur in the presence of high blood pressure in some cases.
If patients start to report symptoms and signs such as having a poor appetite, increased fatigue, an itchy skin, headaches, nausea, or shortness of breath when they present with the mentioned kidney-related problems, then one should consider that the patient may be in renal failure.

Management

Everyone diagnosed with FSGS will be evaluated for the subtype of the disease that they are dealing with and the treatment options will depend on these.

As mentioned, secondary FSGS will be managed by treating the underlying cause of the problem.

In the primary and genetic subtypes of the condition, the patients may be managed with medications such as:

  • Corticosteroids to help reduce inflammation and tissue damage.
  • Antihypertensive drugs such as the ACE inhibitors or ARBs.
  • Immune-suppressing medications.
  • Diuretics to get rid of excess fluid from the body.
  • Dietary changes.
  • Plasmapheresis.
If the condition leads to kidney failure then the only treatment options available for this issue is either dialysis or kidney transplantation.

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