Primum non nocere: Should adults with idiopathic FSGS receive steroids?
Corticosteroids have been widely recommended for the treatment of patients with idiopathic focal segmental glomerulosclerosis (FSGS), despite the lack of evidence-based data to support the use of steroids in this disease. The published studies have a number of limitations. They primarily have been retrospective, have included few patients, and have not been uniform with respect to the steroid treatment protocol. Furthermore, side effects associated with corticosteroid use have not been well documented. The Glomerular Disease Collaborative Network's experience with steroids in idiopathic FSGS has shown a low rate of remission even when steroids were used in the recommended doses and for prolonged periods. Recommendations regarding a specific subset of patients who may benefit from steroid treatment are discussed. The controversies regarding steroids in idiopathic FSGS will only be resolved with data from controlled clinical trials.
Franceschini
Nora
N
Division of Nephrology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Hogan
Susan Lynn
SL
Falk
Ronald J
RJ
D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D013256:Steroids