A kidney disease when causes retention of metabolites, minerals and water results in kidney dysfunction. Focal Segmental Glomerulosclerosis (FSGS) is one of the kidney disorders that results in multiple symptoms. Early symptoms are warning signs and should be evaluated as soon as possible. Delay in elimination of cause of the disease and delay of the treatment can cause irreversible kidney damage. Scarring or hardening of the vessels of the kidney causes the Glomerulosclerosis of the kidney. In this article, we will discuss about the causes, risk factors, symptoms, and treatments rendered for Focal Segmental Glomerulosclerosis (FSGS).
How Is Focal Segmental Glomerulosclerosis (FSGS)?
Focal Segmental Glomerulosclerosis (FSGS) is the scarring or hardening of the glomeruli and the blood vessels of the kidneys. Glomeruli are a shallow funnel like stricture, which holds within funnel blood vessels and capillaries. The funnel and its tube filter water, minerals, and metabolites. Some of the water and minerals are reabsorbed in tube which is attached to funnel. There are several thousands of tiny glomerulus in kidney. The function of the glomeruli is to filter the blood and discard the metabolites as well as excessive minerals and water. Thus urine contains unwanted water, metabolites and minerals. Glomerular abnormalities caused by scarring and abnormal blood vessels results in abnormal reabsorption of metabolites that result in toxic systemic effects on human body. Excessive reabsorption or excretion of water and mineral causes diseases of electrolytes abnormalities. In moderate to severe cases glomeruli start losing protein resulting in proteinuria. Focal Segmental Glomerulosclerosis affects both children as well as adults. Gender wise, it is more prevalent in males than females.
Causes of Focal Segmental Glomerulosclerosis (FSGS)
Idiopathic Primary Focal Glomerulonephritis-
Focal Segmental Glomerulosclerosis generally occurs when cause is unknown. The disease is then known as Idiopathic or Primary Focal Segmental Glomerulosclerosis.
Known Causes of Focal Segmental Glomerulosclerosis (FSGS) Are:
Glomerulonephritis Is Also Associated And Caused By Following Diseases:
- Morbid obesity
- Sickle cell trait
- Birth defects in kidneys
- Heroin or other drug use
- Rarely, genetic
Symptoms of Focal Segmental Glomerulosclerosis (FSGS)
Initial Stage Symptoms of Focal Segmental Glomerulosclerosis (FSGS):
- Specific Symptoms- In Initial stage there are none specific symptoms are observed.
- Non-Specific Symptoms-
- Symptoms like loss of appetite, occasional dizziness, generalized weakness, lethargy and nausea indicates possible electrolyte imbalance.
- These symptoms are often well tolerated and disease is ignored until specific symptoms are observed, which could be advanced stage of the disease.
- Blood examination like electrolyte study and urine examination can help in early diagnosis.
Later Stage Symptoms of Focal Segmental Glomerulosclerosis (FSGS):
Specific Symptoms Are Observed As Follows-
- Swelling which can develop as a result of retained fluid, which may result in swelling in different body parts like hands, feet, abdomen, etc. The swelling mentioned above can get painful and may result in an individual gaining weight quickly.
- Edema of feet
- Increased abdominal fluid- ascites
- Increased fluid around lungs- pleural effusion
- Urine abnormalities
- Uncontrolled hypertension
- Changes in blood pressure- Patient may suffer with high or low blood pressure.
Diagnosis of Focal Segmental Glomerulosclerosis (FSGS)
In order to confirm the diagnosis of Focal Segmental Glomerulosclerosis, the physician may perform a detailed physical examination, which may identify tissue swelling and hypertension. The physician may also discover signs that may indicate renal failure or collection of excessive fluid in the body. Some of the tests to confirm the diagnosis of Focal Segmental Glomerulosclerosis are:
Urine Examination- Urine examination may show following abnormalities-
- Blood in urine
- Increased amount of creatinine
- Increased urine BUN (Blood Urea Nitrogen)
- Increased urine protein also known as proteinuria.
Urine Microscopic Examination- Examinations may show following abnormal findings-
- Increased red blood cells and
- Crystals that are often crescent in shape.
Renal Biopsy- Abnormal finding of biopsy include following abnormalities-
- Abnormal glomeruli
- Infarcted (lack of blood supply) kidney tissue.
Treatment For Focal Segmental Glomerulosclerosis (FSGS)
Unfortunately, there is no clear-cut treatment for Focal Segmental Glomerulosclerosis but there are numerous treatments, which one can slow down disease progression. The symptoms are often less significant with treatment and prognosis suggest treatment does prolong life.
ACE Inhibitors for Focal Segmental Glomerulosclerosis (FSGS)
- Treatment using ACE inhibitors or angiotensin receptor blockers;
- Treats hypertension (increase blood pressure),
- ACE Inhibitors are antihypertensive medications,
- ACE Inhibitors prevent and reduces protein loss in urine.
Corticosteroids for Focal Segmental Glomerulosclerosis (FSGS)
- Suppresses autoimmune reactions, which damages kidney glomeruli
- Prevents further extension of damage of the glomeruli which is already injured by the disease,
- Prevent protein loss
- Protects healthy glomeruli from autoimmune response.
Immune Suppressing Chemotherapy for Focal Segmental Glomerulosclerosis (FSGS)
- Cyclophosphamide is very often used to suppress immune response and glomerular tissue injury by autoimmune reaction caused by diseases triggering glomerulosclerosis.
- Statins for control of cholesterol in the body.
- Anticoagulants for preventing blood clotting.
- Diuretics for removal of excess body fluids and in turn reduce swelling.
- Consumption of a low salt diet.
Unfortunately, Focal Segmental Glomerulosclerosis (FSGS) causes an eventual renal failure even with appropriate treatment. Appropriate treatment and follow up prolongs the kidney damage and need for dialysis. In cases where kidney is severely damaged then patient suffering with advanced Focal Segmental Glomerulosclerosis need to have dialysis and/or kidney transplant.
- National Kidney Foundation. “Focal Segmental Glomerulosclerosis (FSGS).” https://www.kidney.org/atoz/content/focal.
- Mayo Clinic. “Focal Segmental Glomerulosclerosis (FSGS).” https://www.mayoclinic.org/diseases-conditions/focal-segmental-glomerulosclerosis/symptoms-causes/syc-20354221.
- Medscape. “Focal Segmental Glomerulosclerosis.” https://emedicine.medscape.com/article/244631-overview.