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Q. My son has nephrotic syndrome with focal segmental glomerulosclerosis. Please advice.

Answered by
Dr. Geetha Priyadarsini Kamminana
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 14, 2017

Hello doctor,

My 12 year old son is suffering from nephrotic syndrome since the last seven years. Two years ago, when his biopsy was done, the result said FSGS. His creatinine levels at that time was 4. Now it is raised to 10.1. He is currently taking Calcium, Folic acid, Pantoprazole, Sodium bicarbonate and Cilnidipine. Please suggest the course of action.

Dr. Geetha Priyadarsini Kamminana

General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

Please furnish the following medical information, so that I will be able to give you further advice.

  1. What is the cause of focal segmental glomerulosclerosis (FSGS)?
  2. Has dialysis been done? What is his urine output?
  3. What does his antinuclear antibody (ANA) profile say?
  4. Has he been treated with steroids?
  5. Is he on immunosuppressive agents like Cyclophosphamide or Azathioprine?
  • Do attach his biopsy and ultrasound reports as well. I will wait for the same.

Revert with more information to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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Hello doctor,

Thanks for replying. No, he did not undergo any dialysis previously. His urine output is normal. He has been treated with steroids like Omnacortil, Deflazacort, Cyclophosphamide, Tacrolimus, and Mycophenolate mofetil. The cause of FSGS might be Tacrolimus because he was on it when the creatinine levels went up. I have attached his latest reports for your consideration.

Dr. Geetha Priyadarsini Kamminana

General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

  • From the reports (attachment removed to protect patient identity), it clinically appears to be steroid-resistant nephrotic syndrome (SRNS) with a tissue diagnosis of FSGS with calcineurin inhibitor (CNI) toxicity. The treatment is challenging. There are experimental therapies though.
  • Can you please provide me a recent renal biopsy report with immunofluorescence microscopy? Also, kindly attach the latest urine protein, lipid profile, urine microscopy, and sediment examination for my clarity. Treatment can be planned only after seeing the recent biopsy report. If the reports show FSGS, I suggest giving him Rituximab with continuous monitoring.
  • If the FSGS progressed to diffuse global glomerulosclerosis and contracted kidneys, he might need a renal transplantation.  Take care.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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