Focal segmental glomerulosclerosis - symptoms and signs

The disease mostly occurs in children and adolescents , men slightly more than women. A few patients before the onset of upper respiratory tract infection or allergic reactions. The most common first symptom of clinical nephrotic syndrome , about 2/ 3 of the patients had severe edema and proteinuria , urinary protein excretion in 1 ~ 30g / d, about 50 % of patients with hematuria , microscopic hematuria common , occasionally gross hematuria. Adults 30% to 50 % of patients with mild hypertension or persistent manifestations of chronic nephritic syndrome, patients 24h urine protein <3.5g / d, edema obvious, often hematuria , hypertension and renal insufficiency, and 50 % or more can be presented renal comprehensive performance , obviously , " three high and one low" clinical manifestations. A few patients without obvious symptoms , found occasionally in routine urinalysis proteinuria when . This type of sustainable long asymptomatic proteinuria , the prognosis is good . This can also be a small number of patients with end-stage renal failure gradually develop . The vast majority of non-selective proteinuria , but early may have highly or moderately selective . Serum C3 levels were normal , decreased IgG levels. Often proximal tubular dysfunction performance. Upper respiratory infection or allergies can make the symptoms worse. The clinical manifestations of this disease in different pathological types slightly different , typical FSGS and glomerular hypertrophy , less urine protein ; cell type FSGS often massive proteinuria (> 10g / d), and prone to renal insufficiency. 60% of cell type has been reported in patients with FSGS serum creatinine > 2mg/dl, while only 10% of patients with FSGS typically elevated serum creatinine . Collapsing FSGS have relatively significant proteinuria , often > 10g / d, and renal insufficiency is more severe than other types , and hypertension is relatively small. This type of acute onset, rapid progression , usually 1 to 2 years after the onset of end-stage renal failure will enter (ESRF).
Children and adult patients with similar clinical manifestations , mostly dominated nephrotic syndrome , while the proportion of hypertension and renal insufficiency than in adults is low. Most ( 40% to 60% ) of chronic progressive FSGS was , eventually leading to kidney failure , a small number of patients ( 10% to 15% ) and rapid disease progression , earlier onset of kidney failure.