FSGS vs Minimal Change Disease

    
      Re: FSGS vs Minimal Change Disease
    


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Posted by HFHS M.D.-MS on February 23, 1998 at 17:31:41:

In Reply to: FSGS vs Minimal Change Disease posted by Deanne on February 18, 1998 at 15:44:59:

: Hi,
  I'm 34 years old and have been a well-monitored kidney patient for about 25
  years. I don't believe I have spilled less than 1 gram protein in my urine
  over a 24-hour time period since I was about 9 years old. My blood pressure
  started increasing about 10 years ago and is controlled by Ace Inhibitors.
  Currently I am spilling about 4.5 grams with a renal function of about 48%.
  My first successful biopsy was done about three years ago and my Dr at that
  time diagnosed FSGS. A biopsy as a child failed because my kidney kept
  moving away from the needle. (smart kidney!)
  My current Dr says I may have FSGS, Minimal Change Disease or a combination
  of the two. Since I have shown about a 20% decline over the last nine months,
  he has just started me on Prednisone and anticipates keeping me on it long
  term. I know Prednisone doesn't usually do much good for FSGS but it can
  help initiate remission in Minimal Change Disease.
  I've spent a lot of time surfing the net for information, but haven't found
  the answer to my question:
  After so many years, does the actual diagnosis of FSGS vs Minimal Change
  really make much of a difference in my chances for remission? Since there
  has probably been a lot of kidney damage done already, regardless of the
  label given it, I see Prednisone as a somewhat risky long-shot.
  Thanks for any information!
  Deanne
--------------------------------------------------------------------------------
Deane thanks for your questions.
We in Urology deal more with surgery of the kidney and Nephrology deals the medical aspects of the Kidney. In other words I am out of my league but I took the liberty to consult our nephrologist.
Chronic Minimal Change Disease starts to look like Focal Segmental Glomerulosclerosis after a long time.
This does not change the prognosis of the Minimal change disease. As you know the prognosis of MCD is one third get better , one third remain stable and the one third get worse.  The prognosis is dependent on the kidney function.   The only proven treatment is steroids.  Cytoxan ( a chemotherapeutic drug ), cyclosporin ( a immunosuppressive drug used in transplantation ) are for experimental use only.  These drugs are more toxic than prednisone.  There are no trials using these agents at Henry Ford Hospital but you may try the National Kidney Foundation or visit their website at nephron.com  or .org.
You also may benefit from an Angiotensin Converting Enzyme Inhibitor ( medicine for your proteinuria).
With your concerns and thirst for knowledge, you might consider a formal second opinion, to reassure yourself if nothing else.
Hope this has helped.
This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. The Henry Ford Hospital Division of Nephrology has experience in the evaluation and treatment of problems such as you describe. They would be most interested in helping you. You can reach them through our toll-free number (1-800-653-6568). We can also arrange local accommodations through this number if this is  your need. Please bring any x-rays and pathology slides (not just the reports) as well as any physicians