How can increased leakage of protein in the urine be treated?

Q: I am a 27 years old male having Focal Segmental Glomerulosclerosis (FSGS). The doctor prescribed prednisolone 60 mg for a month then Teper 40 mg then reduced the dose to 30 mg then 20mg and 10 mg but gave no good response. So the doctor changed the medications to Tacrolimus and azathioprine but it also did not help. I had 4500 mg albumin leak in my urine daily. Please advise.

A:The biopsy proven Focal Segmental Glomerulosclerosis (FSGS) as in your case characterised by increased leakage of protein (albumin) in the urine (called proteinuria) responds well to a course of steroids (prednisone) if give in an appropriate dose for a set period of time, resulting in significant improvement in proteinuria in 40-80% cases. You did not provide the serum creatinine level since this may also impact the choice of treatment. However, the treatment course pursued in your case is inadequate in both the dosage and the duration of administered steroid. Instead, you should be put on daily dose of 1 mg / kg of Prednisone (approximately 60 mg a day) for at least 3 months while checking the effect on proteinuria.

If proteinuria improves, then we start reducing the dose of steroids gradually over another 2-3 months or may be longer in some cases of partial improvement,instead of suddenly discontinuing it. Additional medications would be required as listed only if FSGS fails to respond to the steroid course at the end of at least 3-4 months treatment. Hence, I would advise a re-evaluation of your treatment course by a nephrologist if not yet done.