Treatment of FSGS of Undetermined Cause or Secondary FSGS in Adults
Adults diagnosed with focal segmental glomerulosclerosis (FSGS) where no definitive immune-mediated cause has been identified — or where FSGS is secondary to an underlying disease process — require a carefully distinguished management approach that differs from immune-mediated FSGS.
Clinical Scenario
This protocol applies to adults with FSGS of undetermined cause (FSGS-UC) and to those with secondary FSGS. In secondary FSGS, the glomerular lesion reflects an underlying primary medical condition, making accurate diagnosis critical before any treatment decisions are made.
Treatment Approach
Management centres on supportive measures indicated for all patients with persistent proteinuria — including renin-angiotensin system (RAS) blockade, blood pressure optimisation, and dietary modification. Patients with secondary FSGS require concurrent management of the underlying primary condition.
The full structured protocol specifies the complete supportive regimen and the evidence-based rationale regarding immunosuppressive therapy in this population. Access the detailed protocol below.
References
- Immunosuppression should not be used in adults with FSGS of undetermined cause (FSGS-UC), or in those with secondary FSGS.
- Patients who have secondary FSGS due to an underlying disease process should be managed as required for the primary medical condition.
- Adult patients with FSGS should receive the necessary supportive treatment as advised for all patients with persistent proteinuria (Chapter 1), including the use of RAS blockade, optimal BP control, and dietary salt restriction.
- There is no evidence or a priori rationale justifying the use of glucocorticoids or other immunosuppressive drugs in this population, and the potential for harm of such treatment is clear.
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