Focal glomerulosclerosis

Minimal-change disease is more common in children than in adults. It is rare in black children and adults of sub-Saharan Africa. Minimal-change responds well to steroids. However, it may recur after prednisone is decreased or discontinued. In such cases, the addition of cyclophosphamide or chlorambucil may produce a response. The GFR is normal. Progression to renal failure does not occur unless focal glomerulosclerosis is present. 

Al. Artero, M. L., Sharma, R., Savin, V. J., and Vincenti, F., Plasmapheresis reduces proteinuria and serum capacity to injure glomeruli in patients with recurrent focal glomerulosclerosis. Am. J. Kidney Dis. 23, 574-581 (1994). 

An 11-year-old boy who had taken lithium for an unstated duration developed nephrotic syndrome with focal glomerulosclerosis which remitted fully after lithium was withdrawn (397). 

Non-steroidal anti-inflammatory drugs are known to induce a nephrotic syndrome in addition to acute tubulointerstitial nephritis (discussed in [77]). Glomerulopathies include minimal change disease, focal glomerulosclerosis that could represent a continuum with the former entity and membranous glomerulopathy. A review of 97 patients with non-steroidal anti-in-... 

Glomerulonephritis may be associated with chronic inflammatory bowel disease and has a heterogeneous expression [113]. Minimal change glomerulonephritis, membranous, membranoprohferative, focal glomerulosclerosis, and proliferative crescentic glomerulonephritis have been described and a summary of these case reports is available in the paper of Wilcox et al. [114]. In almost half of these cases, there was no relationship with drug intake such as sulphasalazine or 5-ASA. 

Figure 1, Renal biopsy of patient with heroin nephropathy showing focal glomerulosclerosis plus severe tubulointerstitial damage.

Segarra A,Vila J, Pou L, Majo J, Arbos A, QuilesT, Piera LL. Combined therapy of tacrolimus and corticosteroids in cyclosporin-resistant or-dependent idiopathic focal glomerulosclerosis a preliminary uncontrolled study with prospective follow-up. Nephrol Dial Transplant 2002 17 655-662. 

Focal Glomerulosclerosis. In contrast to nephritic disorders, in which most patients with active disease have low levels of C3 (see later in this chapter), approximately 30% of patients with idiopathic focal glomerulosclerosis have elevated levels, which indicate a favorable prognosis. 

Nervous system A posterior reversible encephalopathy syndrome in a child with Langerhans cell histocytosis resolved completely when ciclosporin was withdrawn Similar cases have been reported in a 27-year-old man with collapsing focal glomerulosclerosis [2 ] and in a 68-year-old woman and a 19-year-old man after heart transplantation [3 ]. 

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