[Choosing the right treatment approach in focal and segmental glomerular sclerosis with chronic renal failure]. / Il trattamento della glomerulosclerosi focale e segmentaria con insufficienza renale cronica: quale approccio?
G Ital Nefrol
; 25 Suppl 44: S88-S98, 2008.
Article
em It
| MEDLINE
| ID: mdl-19048592
ABSTRACT
Focal and segmental glomerular sclerosis (FSGS) is a heterogeneous disease from a clinical, etiological and clinical point of view. FSGS may be idiopathic, usually associated with nephrotic syndrome, which requires an ''etiological'' treatment approach. In addition, hereditary and secondary forms of FSGS have been described. The response to therapy, including steroids, cytotoxic drugs and calcineurin inhibitors, is considered the best clinical indicator of outcome. Many uncertainties exist regarding the best therapeutic approach to FSGS in patients presenting with chronic renal failure. In this setting, before planning any treatment, the physician should always assess the presence of superimposed functional renal insufficiency and evaluate the severity of the renal impairment, the histological picture, previous immunosuppressive treatments, and the individual patient's risk for side effects. Keeping in mind these considerations and in the absence of appropriate studies, we can formulate the following suggestions 1. there is no absolute contraindication to the use of full-dose prednisone as initial therapy, although the likelihood of a good response is low; 2. the use of cytotoxic drugs is not recommended unless the patient presents with a steroid-responsive form of the disease; 3. in patients with a glomerular filtration rate of less than 40 mL/min, the use of calcineurin inhibitors should be avoided.
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Base de dados:
MEDLINE
Assunto principal:
Glomerulosclerose Segmentar e Focal
/
Citotoxinas
/
Inibidores de Calcineurina
/
Glucocorticoides
/
Imunossupressores
/
Falência Renal Crônica
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
Limite:
Humans
Idioma:
It
Revista:
G Ital Nefrol
Assunto da revista:
NEFROLOGIA
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Itália