Focal segmental glomerulonephritis

Focal segmental glomerulonephritis is the commonest cause of nephrotic syndrome in afro-american adults.

Histologically there are focal areas of sclerosis and on immunofluorescence there is IgM and C3 deposition.

Focal segmental glomerulonephritis may be primary or secondary to:

• reflux nephropathy
• obesity
• Alport's syndrome
• sickle cell disease
• HIV
• heroin use
• IgA nephropathy

Treatment is:

• corticosteroids
• if steroids fail, ? ciclosporin
• if all fails, kidney transplant
• but note that focal segmental glomerulonephritis can recur in the transplanted kidney

Prognosis

• around a third of patients respond to steroid treatment and recover
• around 50% progress to end-stage renal failure

References
Cameron, J. Focal segmental glomerulosclerosis in adults. Nephrol Dial Transplant. 2003; 18 Suppl 6: 45-51.
Fogo, A. Minimal change disease and focal segmental glomerulosclerosis. Nephrol Dial Transplant. 2001; 16 Suppl 6: 74-76.