The Newest Treatment for FSGS

Primary FSGS has become one of the most common causes of idiopathic glomerular disease in adults. The incidence of primary FSGS has increased by 3- to 13-fold during the last 20–30 years, and the disease now accounts for 20%–25% of adult patients undergoing biopsy for evaluation of idiopathic GN; as a result the incidence is almost equal to that of IgA nephropathy and twice that of membranous GN.

In proteinuric patients with primary or secondary FSGS (both non-nephrotic and nephrotic), the initial approach is similar to that in other forms of primary glomerular diseases and consists of optimal BP control and the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). In patients who become or remain non-nephrotic after months of therapy, this remains the primary therapeutic approach. Although the use of ACE inhibitors or ARBs in nephrotic patients with FSGS results in a slower rate of progressive renal insufficiency and better renal survival, it is rare that severely nephrotic patients enter into partial or complete remission with conservative management alone.34 In addition, spontaneous remissions are rare in nephrotic patients with FSGS, occurring in <5% of patients. However, the use of prednisone or immunosuppressive therapy is associated with a significantly increased likelihood of a remission.1 It is therefore in patients who are persistently nephrotic after a course of conservative therapy or in patients presenting with complications from the nephrotic syndrome that more aggressive treatment with prednisone or immunosuppressive agents is recommended. Ultimately, the prognosis of these nephrotic patients with FSGS becomes defined by their response to prednisone/immunosuppressive therapy.37 In patients with nephrotic-range proteinuria due to secondary forms of FSGS (genetic causes, HIV-associated nephropathy, longstanding hypertension, morbid obesity, reflux nephropathy, loss of nephron mass), the mainstay of therapy remains BP control, ACE inhibitors and ARBs, and disease-specific treatment if available (e.g., retroviral therapy in HIV-associated nephropathy). The use of immunosuppressive agents is not beneficial, can be harmful, and is therefore not recommended in these settings.

Immunotherapy and Micro-Chinese Medicine Osmotherapy also take highly effects to prevent the deterioration of FSGS.

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