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Focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis is scar tissue in the filtering unit of the kidney. This structure is called the glomerulus. The glomeruli serve as filters that help the body get harmful substances. Each kidney has thousands of glomeruli.

"Focal" means that some of the glomeruli become scarred. Others remain normal. "Segmental" means that only part of an individual glomerulus is damaged.

Alternative Names

Segmental glomerulosclerosis; Focal sclerosis with hyalinosis

Causes

The cause of focal segmental glomerulosclerosis is often unknown.

The condition affects both children and adults. It occurs slightly more often in men and boys. It is also more common in African Americans. Focal segmental glomerulosclerosis causes up to a quarter of all cases of nephrotic syndrome .

Known causes include:

  • Drugs such as heroin, bisphonsphonates, anabolic steroids
  • Infection
  • Inherited genetic problems
  • Obesity
  • Reflux nephropathy (a condition in which urine flows backward from the bladder to the kidney)
  • Sickle cell disease
  • Some medicines

Symptoms

  • Foamy urine (from excess protein in the urine)
  • Poor appetite
  • Swelling, called generalized edema , from fluids held in the body
  • Weight gain

Exams and Tests

The health care provider will perform a physical exam. This exam may show issue swelling (edema) and high blood pressure. Signs of kidney (renal) failure and excess fluid may develop as the condition gets worse.

Tests may include:

Treatment

Treatments may include:

  • Medicines to reduce the body's inflammatory response.
  • Medicines to lower blood pressure. Some of these medicines also help reduce the amount of protein that spills into the urine.
  • Medicines to get rid of excess fluid (diuretic or "water pill")
  • Low sodium diet  to reduce swelling and lower blood pressure

The goal of treatment is to control the symptoms of nephrotic syndrome and prevent chronic kidney failure .

In general, treatments may include:

  • Antibiotics to control infections
  • Anti-inflammatory medicines to reduce the immune response
  • Dialysis
  • Fluid restriction
  • Kidney transplant
  • Low-fat diet
  • Low- or moderate-protein diet (1 gram of protein per kilogram of body weight per day)
  • Medicines to treat high blood pressure, high blood cholesterol , and high triglyceride levels
  • Salt-reduced diet
  • Vitamin D supplements

Outlook (Prognosis)

More than half of those with focal or segmental glomerulosclerosis develop chronic kidney failure within 10 years.

Possible Complications

When to Contact a Medical Professional

Call your doctor if you develop symptoms of this condition, especially if there is:

Prevention

No prevention is known.

References

Appel GB, Radhakrishnan J. Glomerular disorders and nephrotic syndromes. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 123.

Nachman PH, Jennette JC, Falk RJ. Primary glomerular disease. In: Taal MW, Chertow GM, Marsden PA et al. eds. Brenner and Rector's The Kidney. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 31.

Korbet S. Treatment of Primary FSGS in Adults. JASN. 2012;23(11):1769-1776.

Updated: 7/2/2013

Melissa B Bleicher, MD, Division of Renal, Electrolyte, and Hypertension, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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