Focal Segmental Glomerulosclerosis (FSGS)

Focal segmental glomerulosclerosis (FSGS) happens when scar tissue develops in the glomeruli, some of your kidneys’ filtering units. The scarring prevents your kidneys from filtering waste from your blood, which can cause kidney damage over time and eventually lead to kidney failure. FSGS can affect children and adults, and the cause is often unknown.

The experts at UPMC treat all types of kidney disease. Our team will develop a treatment plan to manage your FSGS symptoms and reduce your risk of complications.

On this page

• What Is FSGS?
• What Are the Symptoms of FSGS?
• How Do You Diagnose FSGS?
• How Do You Treat FSGS?

What Is FSGS?

Focal segmental glomerulosclerosis (FSGS) happens when scar tissue develops in some of the kidneys’ filtering units, called the glomeruli. This scarring prevents your kidneys from filtering waste from your blood, which can cause kidney damage over time and eventually lead to kidney failure. FSGS can affect children and adults, and the cause is often unknown. 

Is FSGS an autoimmune disease?

FSGS is not an autoimmune disease, but an autoimmune disease can cause it.

What are the types of FSGS? 

There are three types of FSGS:

• Primary FSGS — Happens with no known cause.
• Secondary FSGS — Caused by another disease or condition, such as infection, drug use, obesity, medications, or sickle cell disease.
• Genetic FSGS — Also known as familial FSGS, it is caused by a gene mutation (change) inherited from a biological parent.

What causes FSGS?

Primary FSGS happens with no known cause. Genetic FSGS is inherited from a parent who passes a mutated gene to their child.

Secondary FSGS can be caused by a variety of conditions, including:

• Diabetes.
• Infections, such as HIV.
• Kidney disease.
• Lupus.
• Medications, such as bone-strengthening medications and interferons.
• Obesity.
• Recreational drugs, such as heroin and anabolic steroids.
• Sickle cell disease.

What are FSGS risk factors and complications?

FSGS risk factors

Although FSGS is a rare condition, it is most common in males over the age of 45. It occurs more often in people who are Black.

You may be at higher risk of developing FSGS if you have a parent or another relative who has been diagnosed with FSGS. You may be at risk of secondary FSGS if you have another condition that can cause kidney damage.

Complications of FSGS

FSGS can cause serious health complications, including:

• Anemia.
• High blood pressure.
• High cholesterol.
• Swelling in your arms, legs, and face.

Over time, FSGS can cause kidney damage that leads to kidney failure.

How can I prevent FSGS? 

Some types of FSGS have no known cause, so you may be unable to prevent it.

However, you may be able to reduce your risks by:

• Getting treatment for conditions that may cause FSGS.
• Maintaining a healthy body weight.
• Managing chronic conditions and having routine checkups.

How common is FSGS?

FSGS affects about seven out of 1 million people in the general population. It causes about 40 percent of nephrotic syndrome cases in adults and 20 percent of nephrotic syndrome cases in children.  Nephrotic syndrome occurs when there is too much protein in your urine.

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What Are the Signs and Symptoms of FSGS?

Symptoms of FSGS may include:

• Foamy or bubbly urine.
• Poor appetite.
• Swelling, especially in your arms, legs, and face.
• Unintentional weight gain from excess fluids in your body.

When should I see a doctor about my FSGS symptoms?

If you have symptoms of FSGS, or if your symptoms are getting worse after you receive an FSGS diagnosis, you should schedule an appointment with your doctor right away.

You should also contact your doctor if you:

• Develop a fever.
• Have pain when you urinate.
• Urinate less than usual.

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How Do You Diagnose FSGS?

Your doctor will perform a physical exam, talk to you about your health history, and order tests to diagnose FSGS.

What to expect during your visit

During your visit, your doctor will:

• Ask about any medications you’re taking.
• Order blood, urine, or other tests.
• Perform a physical exam.
• Review your health history.

Tests to diagnose FSGS

Your doctor may order blood, urine, or other tests to diagnose FSGS.

Blood tests for FSGS

Blood tests include:

• Blood urea nitrogen (BUN) — Shows how well your kidneys are filtering urea nitrogen, a waste product, from your blood.
• Cholesterol tests — Checks blood cholesterol and triglyceride levels.
• Electrolyte and other tests — Checks for imbalances in electrolyte and mineral levels in your body, such as sodium, potassium, and bicarbonate.
• Estimated glomerular filtration rate (eGFR) — Shows how efficiently your kidneys are functioning based on your age, creatinine level, and sex.
• Serum (blood) creatinine — Shows how well your kidneys are filtering creatinine, a waste product, from your blood.

Urine tests for FSGS

Urine tests include:

• Urinalysis — Looks for abnormalities in your urine, such as a protein called albumin that shows up when your kidneys aren’t working well.
• Urine output — Tracks how much urine your body produces each day.

Other tests for FSGS

Your doctor may order other tests to find the cause of your FSGS. Other less common tests include:

• CT scan — A test that creates images of the organs, bones, and tissues in your body.
• Genetic testing — Looks for gene mutations (changes) that may cause kidney disease.
• Kidney biopsy — A procedure that involves taking small pieces of kidney tissue for examination under a microscope to check for signs of disease.
• Ultrasound — Uses sound waves to create images of your organs to check for problems.

FSGS prognosis

FSGS prognosis varies depending on the type you have, the cause, the severity of symptoms, and your age. Without treatment, FSGS is life-threatening and may lead to kidney failure. Even with treatment, some people with FSGS may eventually need dialysis or a kidney transplant.

Can you recover from FSGS?

FSGS can’t be cured, but it can be managed. Although the kidney damage caused by FSGS can’t be reversed, you may be able to slow the progression of the disease with ongoing treatment. However, you may eventually need dialysis or a kidney transplant.

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How Do You Treat FSGS?

There's no cure for FSGS. However, the goals of treatment are to:

• Help you manage symptoms and maintain an optimal quality of life.
• Protect your kidneys.
• Slow the progression of the disease.
• Treat the underlying cause if it can be identified.

Your FSGS treatments may change as your condition progresses, and treatments may be lifelong.

Treatment options include:

Lifestyle changes

Improving your overall health may help to slow the progression of FSGS or reduce your risk of complications.

Your doctor may recommend that you:

• Control chronic conditions — See a doctor for regular care if you have diabetes or high blood pressure.
• Drink water — Drink plenty of plain water and avoid caffeine.
• Eat healthy — Eat a healthy diet with lots of fruits and vegetables. They're high in potassium, which promotes healthy blood pressure. Limiting salt from shakers and processed foods also helps reduce your blood pressure. Your doctor may also suggest working with a registered dietitian to limit your protein, sodium, fat, cholesterol, and fluid intake.
• Exercise — Aim for at least 30 minutes of moderate-intensity physical activity most days of the week.
• Get preventive care — Check your blood pressure and blood glucose (sugar) routinely.
• Keep track of medications — Inform your doctor if you routinely take over-the-counter drugs or herbal supplements and avoid or limit the use of NSAID medications (ibuprofen, naproxen).
• Manage stress — Take steps to manage stress and get at least seven to eight hours of sleep each night.
• Reduce alcohol intake — Limit alcohol to one drink a day for women and two drinks per day for men or less.
• Stop smoking — Quit smoking if you smoke cigarettes or marijuana.
• Treat kidney conditions — Get treatment right away if you develop kidney stones or a kidney, bladder, or urinary tract infection.

Medicine to treat FSGS

Depending on the cause of your condition and your symptoms, your doctor may recommend:

• Antibiotics to treat infections.
• Blood pressure drugs to reduce your risk of kidney failure.
• Blood thinning medications to prevent blood clots.
• Cholesterol medications to reduce the risk of heart disease.
• Corticosteroids or other medications to suppress your immune system.
• Diabetes drugs to lower your blood sugar.
• Diuretics to regulate fluid levels in your body.
• Pain medications to manage discomfort.

Dialysis for FSGS

If your FSGS progresses to end-stage kidney disease or kidney failure — which is defined as having less than 15% of your normal kidney function — it can cause toxic waste to build up in your body. You may need to have dialysis, also called renal replacement therapy, to filter and clean your blood.

What happens during dialysis?

During dialysis, a machine cleans waste from your blood and helps control your blood pressure.

There are two common types of dialysis:

• Hemodialysis — Performed using a machine at a dialysis clinic or home three times a week for about four hours.
• Peritoneal dialysis — Performed through a catheter in your abdomen at home.

How effective is dialysis for FSGS?

If you have end-stage kidney disease, dialysis is a lifesaving treatment option. Without it, toxins and fluid would build up in your body and cause death within days or weeks.

However, for most people, dialysis is only a short-term treatment. In time, you may need a kidney transplant.

Supportive care without dialysis

Although dialysis treatments are lifesaving for many people, they can be hard and sometimes painful for others.

For people with advanced kidney disease who want to avoid dialysis treatment, renal supportive care can offer hope and comfort.

Supportive care aims to:

• Treat the symptoms of kidney disease.
• Enhance your quality of life.

Kidney transplant to treat FSGS

If you have FSGS that has caused kidney failure, a kidney transplant may be the key to getting you back to your healthy life.

You should talk to your doctor about whether a kidney transplant is an option for you. We partner with UPMC kidney transplant experts to provide care before, during, and after the transplant.

Why choose UPMC for FSGS care?

When you choose UPMC for FSGS care, you will receive:

• Access to world-class nephrology expertise — Our world-renowned experts treat the full spectrum of kidney diseases using the latest diagnostic and treatment techniques.
• A full range of treatment options — We'll work with you to develop a treatment plan that slows the progression of your disease as much as possible and improves your quality of life.
• Multidisciplinary care — We partner with special dialysis clinics, experts in supportive care, and kidney transplant surgeons to ensure you receive complete care.

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By UPMC Editorial Staff. Last reviewed on 2025-04-24 by William Hoffman, MD.