GN: MCD / FSGS

Question 1

Definition of Nephrotic Syndrome

Question 2

What is the pathogenesis of MCD?

Answer 2

1. T cell dysfunction
   - remission with steroid / measles
   - occurs in Hodgkin
   - a/w allergy
   - glucocorticoid / Cyclo proven benefit
2. B cell dysfunction
   - a/w paraprotein
   - responded to Rituximab
   - Ab targetting nephrin (in animal model)
3. Circulating factors

Question 3

What is the link of MCD and FSGS?

Question 4

FSGS biopsy finding?

Question 5

What are the mimics of MCD?

Answer 5

1. FSGS
2. DM nephropathy
3. Membranous Nephropathy
4. Amyloidosis
5. Ig a Nephropathy
6. SLE
7. Alport Syndrome

Question 6

how would you counsel patient prior to steroid therapy?

Answer 6

1. Efficacy
   - CR 90%
   - Steroid resistant 10%
   - Relapse 50-60%
   - Frequent relapse / steroid dependent 25%
2. SE
   - infection
   - weight gain
   - DM
   - AVN
   - osteoporosis

Question 7

FSGS Variant

• Columbia Classification 2004