• Jonathan Hogan and Jai Radhakrishnan.
• Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY. Electronic address: jjh2165@columbia.edu.
• Adv Chronic Kidney Dis. 2014 Sep 1; 21 (5): 434-41.

AbstractFocal segmental glomerulosclerosis (FSGS) is the histologic end point of many disease processes that affect the kidney. Clinically, adults with FSGS present with proteinuria that may be accompanied by the nephrotic syndrome. Once identifiable (secondary) causes are excluded, the diagnosis of idiopathic FSGS, a challenging glomerular disease to understand and manage, is made. On the basis of mostly retrospective data, first-line treatment for idiopathic FSGS patients with nephrotic-range proteinuria is a prolonged course of corticosteroids. However, steroid resistance is common and portends an increased risk of long-term decline in kidney function and end-stage kidney disease in these patients compared with responders. Multiple other immunosuppression regimens have been used in steroid-resistant FSGS, some of which have been studied in randomized controlled trials. Here, we review the data on the treatment for idiopathic FSGS in adults. Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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