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NDT Advance Access originally published online on July 27, 2004
Nephrology Dialysis Transplantation 2004 19(10):2437-2444; doi:10.1093/ndt/gfh320
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Nephrol Dial Transplant Vol. 19 No. 10 © ERA-EDTA 2004; all rights reserved

Editorial Review

Nephrotic focal segmental glomerulosclerosis in 2004: an update

Alain Meyrier

Hôpitaux Broussais et HEGP, Paris, Nephrology and INSERM U430 F-75015 Paris, France

Correspondence and offprint requests to: Alain Meyrier, Service de Néphrologie & INSERM U 430, University Hospitals Broussais & HEGP, 20 rue Leblanc, F-75015 Paris, France. Email: alain.meyrier@brs.ap-hop-paris.fr

Keywords: focal segmental glomerulonephritis (FSGS); genetics of FSGS; idiopathic nephrotic syndrome; immunosuppressive therapy; podocyte

The first 150 words of the full text of this article appear below.

Writing on the treatment of primary focal segmental glomerulosclerosis (FSGS) is a challenge. The jaded nephrologist is tempted to consider that the issue could be summarized as ‘Treatment of a disease which is not a disease but a lesion of obscure pathophysiology, with drugs the mechanism of action of which is poorly understood’ and flinch from the task. However, the knowledge on this topic has so tremendously progressed over recent years that obsolescence looms with each passing year. Let us try to analyse the subject using a Cartesian approach, that is, dissecting the problem step by step. This review will focus on the nephrotic forms of this nephropathy, as mildly proteinuric FSGS is probably a different entity in terms of pathophysiology, prognosis and treatment.

FSGS is not a disease but a lesion with no definite prognostic value

The denomination of the lesion is misleading, as it is not always focal, or segmental, or even sclerotic. Hence, there is a multiplicity of terms, none . . . [Full Text of this Article]

The common denominator of all FSGS variants is a podocyte disease

FSGS, an immunological podocyte disease

FSGS, a viral podocyte disease

FSGS, a toxic podocyte disease

FSGS, an inherited podocyte disease

Treatment of FSGS with corticosteroids

Treatment of FSGS with alkylating agents

Treatment of FSGS with CsA

Treatment of FSGS with other immunophillin modulators

Tacrolimus (FK-506)
Sirolimus (rapamycin)
Treatment of FSGS with mycophenolate mofetil

Relapse on transplanted kidney

Conclusion


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