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My son has nephrotic syndrome with focal segmental glomerulosclerosis. Please advice.

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

My 12 year old son is suffering from nephrotic syndrome since the last seven years. Two years ago, when his biopsy was done, the result said FSGS. His creatinine levels at that time was 4. Now it is raised to 10.1. He is currently taking Calcium, Folic acid, Pantoprazole, Sodium bicarbonate and Cilnidipine. Please suggest the course of action.

Answered by Dr. Geetha Priyadarsini Kamminana

Hello,

Welcome to icliniq.com.

Please furnish the following medical information, so that I will be able to give you further advice.

  1. What is the cause of focal segmental glomerulosclerosis (FSGS)?
  2. Has dialysis been done? What is his urine output?
  3. What does his antinuclear antibody (ANA) profile say?
  4. Has he been treated with steroids?
  5. Is he on immunosuppressive agents like Cyclophosphamide or Azathioprine?
  • Do attach his biopsy and ultrasound reports as well. I will wait for the same.

Revert with more information to an internal medicine physician online.

Patient's Query

Hello doctor,

Thanks for replying. No, he did not undergo any dialysis previously. His urine output is normal. He has been treated with steroids like Omnacortil, Deflazacort, Cyclophosphamide, Tacrolimus, and Mycophenolate mofetil. The cause of FSGS might be Tacrolimus because he was on it when the creatinine levels went up. I have attached his latest reports for your consideration.

Answered by Dr. Geetha Priyadarsini Kamminana

Hello,

Welcome back to icliniq.com.

  • From the reports (attachment removed to protect patient identity), it clinically appears to be steroid-resistant nephrotic syndrome (SRNS) with a tissue diagnosis of FSGS with calcineurin inhibitor (CNI) toxicity. The treatment is challenging. There are experimental therapies though.
    • Can you please provide me a recent renal biopsy report with immunofluorescence microscopy? Also, kindly attach the latest urine protein, lipid profile, urine microscopy, and sediment examination for my clarity. Treatment can be planned only after seeing the recent biopsy report. If the reports show FSGS, I suggest giving him Rituximab with continuous monitoring.
      • If the FSGS progressed to diffuse global glomerulosclerosis and contracted kidneys, he might need a renal transplantation. Take care.

      For more information consult an internal medicine physician online.

Answered byDr. Geetha Priyadarsini Kamminana

Medically reviewed byiCliniq medical review team

Published At June 15, 2017
Reviewed AtApril 20, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Geetha Priyadarsini Kamminana
Dr. Geetha Priyadarsini Kamminana

Internal Medicine

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tacrolimusrituximabsteroidsdialysisnephrotic syndromeazathioprinecalcineurin inhibitorscyclophosphamideantinuclear antibody test (ana) test

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