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Am I taking correct treatment for focal segmental glomerulosclerosis (FSGS)?

Q: I am a 30 years old male having focal segmental glomerulosclerosis (FSGS) problem and leaks 8020 mg protein in urine per day. The doctor gave me first prednisolone 60 mg < 45 mg < 30 mg < 20 mg < 10 mg but no use. Then doctor gave Tacrolimus 3 mg twice daily for six month but it also gave not good result. So, the doctor gave me prednisolone, tacrolimus and azathioprine 150 mg. In this time my urine in albumin +1. Am I taking correct treatment?

A:Focal Segmental Glomerulosclerosis (FSGS) associated with massive protein leakage in urine (proteinuria) as in the mentioned case needs to be treated with prolonged course of steroids at a steady dose for at least 4 months before one can see a response in the form of reduced proteinuria. If there is no effective response at the end of 4 months or so, then azathioprine or tacrolimus is added to the steroid as a combination therapy (using all 3 in the combination is rare). The response is tracked for over a period of several months on the therapy, primarily in the form of degree of proteinuria and underlying kidney function as assessed by serum creatinine level. It seems that there is a notable reduction in the proteinuria in you which mandates probable cut back on the dosage of the combination medications enough to prevent relapse of proteinuria, under the close supervision of your nephrologist. Additionally, you would benefit from the usage of specific kinds of blood pressure lowering medications called ACE, known to delay the progression of kidney disease and also cholesterol lowering medications called statins, if serum cholesterol remains elevated.

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