FSGS can be broadly divided into genetic causes, primary or secondary causes. Leaving genetic aside, how does one differentiate between primary FSGS vs Secondary FSGS ( say from hyperfilatration, Obesity or Anabolic steroids use)?
Clinically and pathologically?
1. Obviously, a good history might help you guide this differentiation.
2. Usually, its a slower increase in proteinuria in secondary cause usually Obesity or hyperfiltration related
3. The proteinuria amount is much much lower in a secondary cause. Someone with 30gm of proteinuria, think more primary
4. The progression to ESRD is also slower in the secondary cause unless probably a drug that is toxic like pamidronate induced collapsing FSGS
5. The pathology usually shows more glomerulomegaly in secondary causes.
6. The pathology usually shows more spotty and irregular foot process effacement in secondary cause and more diffuse in primary cause.
7. Absence of hypoalbumenemia might suggest a secondary cause as well
8. Normal blood pressure and no edema on exam might also suggest a secondary cause( classically seen in HIVAN)
9. Foot process width over 1500nm usually more points towards idiopathic form of FSGS.
Some interesting references:
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- Nephsap review: AKI and ICU Nephrology
- Minimal Change Disease
- IN THE NEWS- CALMAG TRIAL
- TOPIC DISCUSSION: Management of DKA in hemodialysi...
- Nephrology Fellows do better with online training!...
- IN THE NEWS- Barbershop BP management is better th...
- Outcomes of kidney transplantation from HCV positi...
- IN THE NEWS- Permeability Factor and FSGS
- Salivary Prograf levels
- U 002 Nierentransplantation / kidney transplant
- TOPIC DISCUSSION: Green Urine
- FGF-23 and PTH and Bone Disease post transplant
- IN THE NEWS- Bilirubin might be protective
- Aspergilloma in the transplant kidney
- Racial Disparities in CKD, a presentation
- CONSULT ROUNDS: Page Kidney
- Renal Fellow Network: Pancreas transplant pearls
- TOPIC DISCUSSION: Different ARBS
- TOPIC DISCUSSION: Urinary Diversions
- Wait list and desensitization?
- CLINICAL CASE 27, ANSWERS and SUMMARY
- Sirolimus and Male Fertility
- IN THE NEWS:- Tiger on Dialysis
- IN THE NEWS:- Cardiorenal syndrome or renocardiac ...
- NEJM Case
- CONSULT ROUNDS: renal disease
- TOPIC DISCUSSION: Chronic Hyponatremia
- Quiz 7 Answers
- New Transplant Information website
- CONSULT ROUNDS: Free water excretion
- TOPIC DISCUSSION: SECONDARY VS PRIMARY FSGS
- TOPIC DISCUSSION: Maintenance of Metabolic Alkalos...
- REJECTION and TOLERANCE
- KIDNEY WEBSITES IN my languages!
- Renal Fellow Network: Key to angiotensin formation...
- JOURNAL CLUB: AASK TRIAL 2010
- TOPIC DISCUSSION: An uncommon consult:-OHSS!
- IN THE NEWS- Nephrology Workfore
- Basic concepts in Immunology
- Role Playing exercise in Transplant Education
- TOPIC DISCUSSION
- CLINICAL CASE 26 , ANSWER and SUMMARY
- ▼ October (42)