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Other immunosuppressive agents for focal segmental glomerulosclerosis
Claudio Ponticelli1, Patrizia Passerini
1Division of Nephrology, IRCCS, Ospedale Maggiore, Milano, Italy.
Seminars in Nephrology
|April 22, 2003
Summary
Corticosteroids are the first-line treatment for focal segmental glomerulosclerosis (FSGS). For steroid-resistant patients, prolonged cytotoxic agents or mycophenolate mofetil (MMF) show promise, while plasmapheresis and LDL apheresis require further study.
Area of Science:
- Nephrology
- Immunosuppression Therapy
- Glomerular Diseases
Background:
- Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome.
- Corticosteroids are the initial treatment, but many patients develop steroid resistance.
- Alternative therapies are needed for refractory FSGS cases.
Purpose of the Study:
- To review current therapeutic options for FSGS, particularly in steroid-resistant cases.
- To evaluate the efficacy and limitations of various immunosuppressive and apheresis treatments.
- To provide guidance on managing patients with difficult-to-treat FSGS.
Main Methods:
- Review of existing literature on FSGS treatments.
- Analysis of outcomes for cytotoxic agents, mycophenolate mofetil (MMF), plasmapheresis, and LDL apheresis.
- Comparison of treatment effectiveness in steroid-sensitive versus steroid-resistant populations.
Main Results:
- Prolonged cytotoxic therapy with corticosteroids is effective in over half of steroid-resistant children but less so in adults.
- Mycophenolate mofetil (MMF) may reduce proteinuria but rarely achieves complete remission; long-term data are lacking.
- Plasmapheresis and LDL apheresis show promising preliminary results, but require larger, controlled studies.
Conclusions:
- Treatment for steroid-resistant FSGS remains challenging and debated.
- A 6-month trial of cytotoxic agents or MMF can identify responsive patients.
- Further research is essential to establish the role of plasmapheresis and lipopheresis in FSGS management.