Steroid-Resistant FSGS: What to Do

2019-03-17 16:15

Steroid-Resistant FSGS: What to DoFSGS is not a single disease, but a clinical-pathological diagnostic term caused by a variety of etiologies, with a variety of pathological changes. Most FSGS patients are steroid-resistant. Then what to do?

The prognosis of FSGS patients is closely related to whether they can get remission of Nephrotic Syndrome.

According to Kobert's data, less than 15% of patients with remission of nephrotic syndrome had renal failure during 5-year follow-up, while 50% of patients with remission of nephrotic syndrome had renal failure after 6 years. Therefore, it is very important to obtain remission of nephrotic syndrome if you want to have a good prognosis.

Unfortunately, about 60-70% of FSGS patients are steroid-resistant.

For patients with primary FSGS who are ineffective in conventional dose and course of steroid therapy, the partial remission rate can be increased by prolonging the time of steroid use.

Before steroid resistance is determined, it is recommended to adhere to the use of high-dose steroids for 4 to 6 months, and then prolong the use of low-dose steroids.

In patients whose oral prednisone is indeed ineffective, some scholars suggest that methylprednisolone be intravenously dripped 30mg/kg.d (the maximum dose is less than 1.0g/d), once every other day for six times, then once a week for 10 weeks, and then slowly reduced. Others also add cytotoxic drugs such as CTX or leukeran, which can increase the remission rate of 50% patients.

CsA has a better therapeutic effect on steroid-resistant FSGS.

However, rebound after discontinuation is very common, and long-term use has the potential risk of renal tubular atrophy and interstitial fibrosis. Therefore, the dosage and course of CsA are the most concerned problems. Most scholars suggest that the dosage of CsA should be controlled below 5 mg/kg.d. In patients with creatinine clearance less than 60 ml/min or with obvious tubulointerstitial damage at the first renal biopsy, CsA should be avoided. During the use of CsA, when there is 30% increase in serum creatinine, it should be stopped, and the changes of renal function should be closely observed.

FK506 is considered to be an alternative to CsA.

There are also reports on the treatment of steroid-resistant FSGS with mycophenolate, but the number of patients is small, and the long-term efficacy is yet to be observed.

Plasma Exchange or Immunoabsorption can be used to treat the recurrence of FSGS in renal transplant patients. An analysis of plasma extracts from patients with recurrent FSGS after kidney transplantation revealed a substance called circulating factor, which may be associated with changes in glomerular protein permeability in FSGS patients. Plasma exchange can reduce proteinuria, but there is no strong evidence to prove its long-term effect.

If you do not like the above western medicine, you can try Toxin-Removing Treatment.

This treatment can help you turn proteinuria negative. It can also help repair kidney damage and restore renal function so as to reduce the relapse of FSGS.

What to do with steroid-resistant FSGS? Now you get the answer. For more information on FSGS treatment, please leave a message below or contact online doctor.

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