Focal segmental glomerulosclerosis (FSGS) is a cause of nephrotic syndrome and chronic kidney disease. It generally presents in young adults.

Most common cause of nephrotic syndrome in adults

Causes

• idiopathic
• secondary to other renal pathology e.g. IgA nephropathy, reflux nephropathy
• HIV
• heroin
• Alport's syndrome
• sickle-cell

Pathophysiology:

• A circulating permeability factor causes the increased protein leak; plasma from patients increases membrane permeability in isolated glomeruli.
• Segmental glomerulosclerosis is seen on light microscopy, which later progresses to global sclerosis.

Presentation

• massive proteinuria (nephrotic synrome)
• haematuria
• hypertension
• renal impairment - CKD