Webinar: Focal and Segmental Glomerulosclerosis: A practical approach to evaluation

This webinar was held on 11 July 2014, 12:00 PM- 1:00 PM EDT US Eastern time

Description of the Webinar

Focal and segmental glomerulosclerosis (FSGS) is a glomerular lesion not a disease entity.  It is the consequence of a wide-array of underlying pathobiologic mechanisms including toxic or viral-induced podocyte injury, glomerular inflammation, hemodynamic alterations, metabolic disturbances (such as obesity) and genetically-based perturbations of podocyte survival and repair.  It is not synonymous with focal and global glomerulosclerosis (FGGS), which is often associated with hypertension and chronic kidney disease (CKD) in African-Americans, physiologic aging and/or tubular disorders.  Idiopathic (or Primary) FSGS is a “diagnosis” of exclusion of secondary forms.  This process requires complete investigation by optical, immunofluorescence and most importantly electron microscopy. By optical microscopy FSGS can be broken down into five variants (not-otherwise specified, peri-hilar, cellular, tip and collapsing) but this sub-classification is of limited value in the separation of primary from secondary FSGS.  Primary FSGS is more commonly associated with a full-blown nephrotic syndrome, including proteinuria >3.5gms/d, a low serum albumin and edema formation.  By electron microscopy diffuse foot-process effacement (>80%) is most often seen in primary FSGS, but this also can be seen in FSGS secondary to toxic  and viral induced podocyte injury.  At the moment there are no serum or urinary biomarkers that can reliably separate primary from secondary FSGS, but recent data on the use of urinary soluble urokinase plasminogen activator receptor (suPAR) levels are encouraging.  Clear separation of primary from secondary FSGS is crucial, as each category differs in prognostic connotations and treatment regimens.

Webinar Webcast

About the Facilitators

Professor Richard Glassock MD, MACP is an internationally recognized expert in the field of Glomerular Diseases and Clinical Nephrology.  He has published over 550 original papers, books, book chapters and reviews.   He is the past-president of the American Society of Nephrology and the National Kidney Foundation and past-Chairman of the American Board of Internal Medicine. He is a member of the American Association of Physicians and in 1999 was elected to Mastership in the American College of Physicians. He is the former Chair of the Departments of Medicine at the University of Kentucky (1992-1999) and Harbor-UCLA Medical Center (1980-1992). From 1967 to 1980 he was also the Chief of Nephrology at Harbor-UCLA Medical Center. He was continuously funded by the NIH from 1967 to 1992 for his research in renal immuno-pathology.