Aggressive treatment of severe idiopathic focal segmental glomerulosclerosis.
When focal segmental glomerulosclerosis (FSGS) has reached the stage of chronic renal insufficiency, further progression is usually considered inevitable. African-American patients are believed to exhibit a particularly aggressive form of FSGS. We have treated five African-American patients, aged 11-18 years, with FSGS and reduced renal function using intensive intravenous methylprednisolone protocol, combined with chlorambucil in three cases. All patients had a pretreatment creatinine clearance of less than 50 ml/min per 1.73 m2. Three patients responded with normalization of creatinine clearance and serum albumin levels and had no or only minimal proteinuria at latest follow-up. One patient showed no improvement and one patient progressed to end-stage renal disease. These findings indicate, for the first time, that even severe FSGS may respond to aggressive methylprednisolone with or without alkylating agent treatment, and that African-American race does not preclude a favorable response.
Aviles
D H
DH
Department of Pediatrics, Louisiana State University Medical Center and Children's Hospital, New Orleans 70118, USA.
Irwin
K C
KC
Dublin
L S
LS
Vehaskari
V M
VM
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D044383:Black People; D002648:Child; D002675:Child, Preschool; D002699:Chlorambucil / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D001741:Black or African American
D000893:Anti-Inflammatory Agents; D018906:Antineoplastic Agents, Alkylating; D002699:Chlorambucil; D008775:Methylprednisolone