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A relatively common renal pattern of injury
May result from damage to podocytes; such damage may be
Primary renal-limited disorders fall into three categories
Heritable abnormalities in any one of several podocyte proteins or to underlying type 4 collagen mutations
Polymorphisms in the APOL1 gene in patients of African ancestry
Increased levels of a circulating permeability factor
Secondary causes include renal overwork injury, obesity, hypertension, chronic urinary reflux, HIV or SARS-CoV-2 infection, or analgesic or bisphosphonate exposure
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Supportive care for nephrotic patients
Prednisone, 1 mg/kg/day orally for 4–16 weeks followed by a slow taper reserved for cases of nephrotic primary focal segmental glomerulosclerosis presumed to be due to a circulating permeability factor
Patients with secondary focal segmental glomerulosclerosis do not benefit from immunosuppressive therapy; treatment should be directed at the inciting cause
Calcineurin inhibitors (eg, cyclosporine, tacrolimus, pimecrolimus) and mycophenolate mofetil can be considered for patients with steroid-resistance
Plasma exchange therapy, and possibly rituximab, appear to be beneficial in lowering risk of graft loss in patients just prior to kidney transplantation and in lowering risks of relapse in those exhibiting early signs of relapse