Evidence suggesting under-treatment in adults with idiopathic focal segmental glomerulosclerosis

Primary Focal Segmental Glomerulosclerosis. Clinical Course, Predictors of Renal Outcome and Treatment.

“…no more than 10%of patients progress to ESRD.A sustained remission carries a good prognosis, whereas recurrence of nephrotic syndromemayindicate a poor prognosis similar to primary non-responders (9, ll). Relapse is seen in only 15% of adult patients, in comparison to 80%in children (14). Most patients re-enter a remission regardless of age (12,14).…”

“…Relapse is seen in only 15% of adult patients, in comparison to 80%in children (14). Most patients re-enter a remission regardless of age (12,14).…”

“…As for hypertension, it is now believed to be an important factor in the progression of glomerulonephritis (6,20). However, hypertension at presentation of FSGShas not been found to be of prognostic significance (12,14,19), suggesting that hypertension at presentation is induced by hemodynamicchanges, not by permanent histological changes. Controversy exists whether race influences the outcomeof disease.…”

“…The recent increase in completeremission appearsto correlate with increased duration of steroid therapy, often with 5 to 8 months (5). In several studies, the meantime to remission takes 3 to 4 months (10,12,14). Therefore, steroid therapy should continue as long as possible in order to recognize the few responders (40).…”

Treatment of Steroid-Resistant Nephrotic Syndrome

“…In a majority of studies published, the response rate has been less than 30% [10]. Pei et al [11] reported that, using a more prolonged course of prednisolone therapy, 44% of children with idiopathic FSGS entered complete remission. The available evidence on the efficacy of such treatment is inconsistent and therefore it is more appropriate, effective and more gentle to the patient to introduce other immunosuppressive drugs at this juncture.…”