Focal segmental glomerulosclerosis – Corticotherapy response: A case raport
Abstract
Focal segmental glomerulonephrosis (FSGS) is a renal disorder with significant presence of proteinuria (usually in the nephrotic range) and glomerular damage, which affects children and adults. The diagnostic finding is made by means of renal biopsy, where podocyte alterations will be observed. The objective of this study is to report the case of a patient diagnosed with focal segmental glomerulonephrosis. The case report is of a 27-year-old Caucasian female patient who presented with edema of the extremities of the lower limbs and foamy urine. The findings described by light microscopy and immunofluorescence characterize a case of FSGS. After the tests, the patient started using 40 mg/day of furosemide and 20 mg/day of prednisone, in addition to pulse therapy with methylprednisolone, with a new increase in 24-hour proteinuria, recurrent hospitalizations and clinical decompensation in anasarca. Treatment with cyclophosphamide alternated with methylprednisolone was initiated, with improvement in proteinuria since then. Corticosteroids are the choice for the treatment of FSGS, although there is uncertainty about the risks and benefits. In cases of non-remission with corticosteroid therapy, cyclosporine associated with prednisone is chosen, which can cause total remission in many patients. Mycofelonate mofetil may be used as an alternative in non-responders. If resistance persists and with frequent protein increases, a regimen with cyclophosphamide in association with prednisone and with constant follow-up is indicated. The use of calcineurin inhibitors has shown positive effects in the treatment of FSGS. To date, the mechanisms involved in FSGS have not been accurately described, a fact that hinders the treatment of this pathology, and it is crucial that current and future studies comprehensively examine individuals to identify the characteristics of those who respond and those who do not respond to the treatment of the disease.
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Copyright (c) 2024 Nathalie Borges Costa, Vanessa Teodoro Laureano Cândido, Sumaya Vieira Canêdo Prudente, Daiany Caixeta Campos, Victor Hugo Barbosa Roriz, Marcos Antônio Moreno Silveira, Hellida Patricia Oliveira Camilo Pereira, Afonso Lucas Oliveira Nascimento, Cibelle Camilo Barbosa JardimAuthor(s)
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Nathalie Borges Costa
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Vanessa Teodoro Laureano Cândido
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Sumaya Vieira Canêdo Prudente
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Daiany Caixeta Campos
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Victor Hugo Barbosa Roriz
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Marcos Antônio Moreno Silveira
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Hellida Patricia Oliveira Camilo Pereira
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Afonso Lucas Oliveira Nascimento
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Cibelle Camilo Barbosa Jardim