Reflux nephropathy is most likely to cause?(AIIMS May 11)
|C||Focal & segmental|
Etiology of Focal and Segmental Glomerulosclerosis
1. Idiopathic (majority)
2. In associated with systemic diseases or drugs : i. HIV infection ii. Diabetes mellitus
3. As consequence of sustained glomerular capillary hypertension
i. Congenital oligo nephropathies ii. Unilateral renal agenesis
iii. Reflux nephropathy iv. Glomerulonephritis or tubulointerstitial nephritis
v. Sickle cell nephropathy vi. Heroin use
1. Proteinuria is present and is usually nonselective.
2. Hypertension, reduced GFR, abnormal tubular function and abnormal urinary sediments (leukocyturia, hematuria) are seen.
3. Hyperlipidemia is severe in cases with focal sclerosis.
Prognosis is variable. In steroid responsive patients, prognosis is good, but in steroid unresponsive patients and in patients with heavy proteinuria rapid progression to end stage renal failure occurs within a few months. Cyclosporine or tacrolimus, as an adjunctive therapy to steroids, may be beneficial in some cases.
1. FSGS may develop following acquired loss of nephrons from reflux nephropathy.
2. Proteinuria is nonselective in most case and may be in (Nephritic range) or nephrotic range.
3. Association of reflux nephropathy and proteinuria suggest an irreversible glomerular lesion most commonly FSGS
a. Prolonged glucocorticoid therapy (i.e., >6 months) may lead to remission of proteinuria.
b. Cyclosporine as well as ACE inhibitors may be effective in reducing proteinuria.