DR Medhat MRCP

Management :
1 st line TTT is steroids :
- Prednisolone 1mg/kg/d X at leas 4 weeks if tolerated , continue for 16
weeks or until remission is achieved then taper over 6 months.
Response of FSGS to steroids :
• FSGS is slow to respond to steroids & shorter courses of steroids are not useful.
• Unlike MCD , degree of proteinuria often persist.
• Complete remission (i.e proteinuria < 300mg/d + normal s. Albumin + normal
RFT) or incomplete remission (i.e proteinuria < 3.5 g/d but > 300 mg/d + 50%
reduction from baseline + stable RFT) occur in 40-60 % of cases.
• Steroid resistant FSGS : i.e no remission at 16 weeks of ttt.
• Steroid dependent FSGS : i.e relapse on withdrawal of steroids or in 2wks after
DC
2 nd line ttt immunossuppresion:
Indications of starting immune suppression in FSGS :
1) Steroid resistant or steroid dependent FSGS.
2) For patients with poor prognostic features who are not expected to
هام respond to steroids e.g
• Severe proteinuria (e.g. >10g/day).
• Progressive CKD.
• Interstitial fibrosis on histology.
• Black race.
• No response to treatment.
• Histology: presence of collapsing variant (bad) or tip lesion (good).
a) Continue low dose prednisolone.
b) Add calcinurin inhibitor :
o Ciclosporin :
- 3-5 mg/kg/d in divided doses X 6 months aiming at trough
level 125-225 ng/mL.
- Measure baseline GFR.
- If remission occurs ( in 70% of cases), continue for 12 months
then taper the dose & DC.
- Cilcosporin-dependence is common.
o Tacrolimus is an alternative:
- 0.1-0.2 mg/kg/d in divided doses
c) MMF or cyclophosphamide + steroids: may be used (not evidence based).
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