By Sharma S Prabhakar
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Additional info for An update on glomerulopathies : clinical and treatment aspects
Protracted use of intravenous albumin should be discouraged; the regimen is expensive and ineffective, because most of the infused albumin is lost in the urine. Continuous IV drip of furosemide is preferred over large boluses of IV push to avoid side effects. Control of hypertension is one of the most important aspects of overall management in FSGS, like any other glomerular disease. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are nonspecific agents that reduce proteinuria because of their antihypertensive and intrarenal hemodynamic effects of reducing glomerular capillary pressure and resistance.
For example, patients who possess genetically defective podocytes should be unresponsive to conventional steroid treatment. Similarly, these patients should not have recurrent FSGS when transplanted with a structurally normal kidney allograft. Furthermore, family members who are potential living donors could be genetically screened for mutations associated with the development of kidney disease and excluded as candidate donors. 3. Secondary FSGS Secondary FSGS can be seen in a variety of conditions such as renal agenesis, obesity, or sickle cell disease etc where hyperfiltration is a characteristic abnormality.
In this report, he hypothesized that the progression to end stage renal disease (ESRD) in a subset of children with idiopathic nephrotic syndrome was because of the development of glomerular sclerosis. Churg et al published histopathological classification of nephrotic syndrome in children for the International Study of Kidney Disease in Children (ISKDC) in 1970, and the disease entity of FSGS was emphasized as a clinicopathological entity separate from minimal change disease (MCD) by its marked resistance to steroids and progression to ESRD.