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Focal Segmental Glomerulosclerosis (FSGS)

Primary and Secondary Podocyte Injury

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

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What is Focal Segmental Glomerulosclerosis (FSGS)?

FSGS describes focal (some glomeruli) and segmental (part of each glomerulus) sclerosis with podocyte injury on biopsy.

Variants include classic NOS, perihilar, tip, cellular, and collapsing — each with prognostic and therapeutic implications.

Etiologies classified as primary (circulating permeability factor), secondary (viral, medications, obesity, reflux, reduced nephron mass), and genetic (NPHS1, NPHS2, APOL1).

Presents with nephrotic syndrome or asymptomatic proteinuria and frequently progresses to end-stage kidney disease.

Symptoms

Heavy proteinuria and foamy urine
Generalized edema, periorbital and lower extremity
Hypertension
Microscopic hematuria in some cases
Weight gain from fluid retention
Features of hyperlipidemia and hypoalbuminemia

Risk Factors

African ancestry with APOL1 high-risk variants
Obesity, reduced renal mass (single kidney, reflux nephropathy)
HIV, parvovirus B19, or CMV infection
Medications (pamidronate, interferon, heroin, anabolic steroids)
Family history of kidney disease or nephrotic syndrome
Chronic kidney disease with hyperfiltration

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Nephrotic-range proteinuria or new-onset edema
  • Rising creatinine with proteinuria
  • Resistant or frequently relapsing nephrotic syndrome

Treatment Methods

01
Identify and treat secondary causes (weight loss, antiretroviral therapy, stop offending drugs)
02
ACEi or ARB titrated with sodium restriction for proteinuria in all forms
03
SGLT2 inhibitor to reduce proteinuria and slow CKD progression
04
Primary FSGS: high-dose corticosteroids for 8-16 weeks; consider calcineurin inhibitors (tacrolimus, cyclosporine) for steroid-resistant/dependent disease
05
Genetic FSGS: supportive care; immunosuppression generally ineffective
06
Manage complications: anticoagulation if severe nephrotic syndrome, statins for dyslipidemia, loop diuretics for edema

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.