FSGS الأولي مع متلازمة الكلوية — ما الذي يجب فعله عندما لا يحقق العلاج بمثبطات الكالسينيورين الهدأة

References

We recommend that high-dose oral glucocorticoids be used as the first-line immunosuppressive treatment for primary FSGS (1D).

In adults with relative contraindications or intolerance to glucocorticoids, alternative immunosuppression with CNIs should be considered as the initial therapy in patients with primary FSGS (Figure 54).

Adults who have steroid-resistant primary FSGS with resistance to or intolerance of CNIs should be referred to specialized centers for consideration of rebiopsy, alternative treatment, or enrollment in a clinical trial (Figure 55).

In considering these issues, the KDIGO 2021 Work Group agreed that it would be more appropriate to remove the use of MMF and high-dose dexamethasone as a clinical recommendation and consider this as an alternative treatment possibility when other therapeutic options have failed.