Focal Segmental Glomerulosclerosis (FSGS) is scar tissue that forms in parts of the kidneys' tiny filters called glomeruli. The glomeruli function to help rid the body of unnecessary or harmful substances. Each kidney has thousands of glomeruli.For people with FSGS, their renal functional cells present global sclerosis and fibrosis progressively. Eventually, kidneys will fail to work. Patients have to undergo dialysis and even kidney transplant. Therefore, early treatment to reverse this vicious development is necessary.
Causes of Focal Segmental Glomerulosclerosis (FSGS)
1. The main causes of FSGS include two aspects: the internal kidney reason like reduced immunity and the external kidney reason like antigens of the infection, cold, etc. In case of the decrease of immunity, the pathologic foreign bodies, as some type of antigens, will combined with antibody after invading into human body, and then form immune complex (mainly featured by IgG and C3 deposition).
The special epitopes in the kidneys can attract the immune complexes, so the immune complexes will flow with blood circulation and deposit in the glomerular capillary loops, which gives rise to segmental hyaline degeneration in the epithelial cells of the glomerulus. As a result, the surface of epithelial cells of the glomerulus is desquamation, and inflammatory mediator continues to invade, leading to the damages of epithelial cells barrier function. Proteins in the blood will run into urine, and then get discharged out of body. Meanwhile, after epithelial cells get damaged, they will turn into myofibroblast, resulting in glomerular sclerosis, and start the process of renal fibrosis.
2. Secondary FSGS
* Secondary to viral infections such as HIV, parvovirus, and hepatitis B.
* Massive obesity
* Sickle cell nephropathy
* Congenital cyanotic heart disease
Prognosis
Since idiopathic FSGS is difficult to treat, most patients with FSGS develop to total kidney failure 5~20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years.
The prognosis of FSGS can be influenced by clinical manifestations, pathological changes of renal tissue and curative effect of treatment.
▪ Clinical manifestations
If patients are accompanied with persistent Nephrotic Syndrome, the survival rate for about 10 years is 45%, while the non Nephrotic Syndrome patients can achieve 90%. The prognosis is bad for patients with severe hyperlipidemia and severe proteinuria.
▪ Pathological changes
If the pathological change of FSGS is accompanied with diffuse mesangial proliferation, obvious arteriolosclerosis, renal tubule interstitial infiltration of inflammatory cells and interstitial fibrosis changes, the prognosis is bad.
▪ Curative effect of treatment
Treatment involving steroids or other immunosuppressive drugs appears to help patients by reducing proteinuria and improve kidney function. But these treatments are beneficial to only a minority of patients in whom they are tried, and some patients may have even poorer kidney function as well as poor prognosis.
Prevention
▪ Have a healthy diet which should be low in sodium and protein. ▪ Avoid stimulating foods and high-fat foods.
▪ Do regular physical activities.
▪ Quit smoking, and drink alcohol moderately.
▪ Reduce the stress in daily life through counseling, doing stress reduction exercises, and meditation.
▪ Take medicine to help control the blood pressure and/or cholesterol levels.
