Challenges in primary focal segmental glomerulosclerosis diagnosis : from the diagnostic algorithm to novel biomarkers
Jacobs-Cachá, Conxita (Vall d'Hebron Institut de Recerca (VHIR))
Vergara, Ander (Hospital Universitari Vall d'Hebron)
García-Carro, Clara (Red de Investigación Renal (REDINREN))
Agraz Pamplona, Irene (Red de Investigación Renal (REDINREN))
Toapanta, Néstor (Vall d'Hebron Institut de Recerca (VHIR))
Ariceta Iraola, Gema (Hospital Universitari Vall d'Hebron)
Moreso, Francesc (Vall d'Hebron Institut de Recerca (VHIR))
Seron, Daniel (Vall d'Hebron Institut de Recerca (VHIR))
López-Hellín, Joan (Hospital Universitari Vall d'Hebron)
Soler, María José (Vall d'Hebron Institut de Recerca (VHIR))
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Primary or idiopathic focal segmental glomerulosclerosis (FSGS) is a kidney entity that involves the podocytes, leading to heavy proteinuria and in many cases progresses to end-stage renal disease. Idiopathic FSGS has a bad prognosis, as it involves young individuals who, in a considerably high proportion (∼15%), are resistant to corticosteroids and other immunosuppressive treatments as well. Moreover, the disease recurs in 30-50% of patients after kidney transplantation, leading to graft function impairment. It is suspected that this relapsing disease is caused by a circulating factor(s) that would permeabilize the glomerular filtration barrier. However, the exact pathologic mechanism is an unsettled issue. Besides its poor outcome, a major concern of primary FSGS is the complexity to confirm the diagnosis, as it can be confused with other variants or secondary forms of FSGS and also with other glomerular diseases, such as minimal change disease. New efforts to optimize the diagnostic approach are arising to improve knowledge in well-defined primary FSGS cohorts of patients. Follow-up of properly classified primary FSGS patients will allow risk stratification for predicting the response to different treatments. In this review we will focus on the diagnostic algorithm used in idiopathic FSGS both in native kidneys and in disease recurrence after kidney transplantation. We will emphasize those potential confusing factors as well as their detection and prevention. In addition, we will also provide an overview of ongoing studies that recruit large cohorts of glomerulopathy patients (Nephrotic Syndrome Study Network and Cure Glomerulonephropathy, among others) and the experimental studies performed to find novel reliable biomarkers to detect primary FSGS.
Ajuts:	Instituto de Salud Carlos III PI17-00257 Instituto de Salud Carlos III PI18-01704 Instituto de Salud Carlos III PI18-01832
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Biomarkers ; Diagnosis algorithm ; Focal segmental glomerulosclerosis ; Idiopathic nephrotic syndrome ; Primary FSGS
Publicat a:	Clinical Kidney Journal, Vol. 14 (august 2020) , p. 482-491, ISSN 2048-8513

DOI: 10.1093/ckj/sfaa110
PMID: 33623672

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