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| Intermed. mag. Image: Focal segmental glomerulosclerosis - high mag.jpg (Photo credit: Wikipedia) |
FSGS or focal and segmental glomerulosclerosis is the most common non diabetic cause of nephrotic syndrome in the world. This is particularly true among African Americans. The treatment of this disorder is frequently complicated by non response to the primary modality of treatment which is steroids. Combine this with the need for high doses to produce an effect, the known toxicity of steroids and we begin to see there is need for a better drug. Unfortunately many of the drugs attempted are also toxic or produce a situation of dependence where the disease may go into remission but it quickly relapses when the drug is discontinued. Rituximab is a drug that has had some success in lupus nephritis and now it is undergoing trials in patients with FSGS. The current study by investigators from spain, looked at a small cohort of 8 patients and found that rituximab was effective only in the minority of patients, only 3 patients had a favourable response to the drug. It is however interesting that in at least one patient that responded there was a durable massive reduction in proteinuria. The fact that this occurred should inspire some hope that the drug may be useful if an effective regimen capable of benefiting more patients can be elucidated.
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