Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV sources)
There are several case series documenting improvements in proteinuria and delay in progression to end-stage kidney disease (ESKD) following disease-specific interventions in patients with secondary focal segmental glomerulosclerosis (FSGS). (Level IV evidence, variable response, anecdotal reports)
- Anecdotal case reports suggest the potential for dramatic improvement in both renal function and structure in patients with HIV-FSGS with the use of highly active antiretroviral therapy (HAART). There are currently no well-controlled studies demonstrating the effect of long-term HAART on renal outcomes.
- Effective therapy of the malignancy may lead to remission of proteinuria in the rare patient with tumour-induced FSGS.
- FSGS may not regress after thymectomy in patients with thymoma.
- FSGS does not remit on successful elimination of the living parasites in schistosomiasis-associated FSGS.
- There are case reports where elimination of Hepatitis C (HCV) infection has been associated with remission of proteinuria in patients with HCV-associated FSGS.
- Obesity-associated FSGS may be improved by weight loss and improvement of insulin sensitivity.
To be most effective, therapy needs to be given to patients with early histological lesions and mild proteinuria/renal impairment, hence the need for prompt identification of any underlying illness if patients are to be managed successfully. (Level IV evidence, anecdotal reports)
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test