View source for Focal Segmental Glomerulosclerosis

== Systemic Involvement  ==

“The natural history of FSGS varies a great deal. A typical course runs from edema that is difficult to manage to proteinuria refractory to corticosteroids and other immunosuppressive agents to worsening hypertension and progressive loss of renal function. In patients who do not respond to therapy, the average time from the onset of gross proteinuria to End Stage Renal Disease (ESRD) is 6-8 years, although wide variations in the time course occur. One of the key factors that determine renal survival is the persistence and degree of proteinuria. In patients with unresponsive massive proteinuria of greater than 10 g/d, most will develop ESRD within 5 years.”&nbsp;<ref name="Rao" /> 

“Pleural effusion and ascites may be present; pericardial effusions are rare. Gross edema may predispose patients to ulcerations and infections in dependent areas, such as the lower extremity. Abdominal pain, a common finding in children, may be a sign of peritonitis. Rarely, xanthomas may be evident in association with severe hyperlipidemia. In many patients, physical examination findings are normal except for generalized or dependent edema.” 

“Severe hypertension with a diastolic blood pressure of 120 mmHg or more is not uncommon, especially in African American patients with renal insufficiency. Rarely, patients experience severe renal failure with signs and symptoms of advanced uremia (nausea, vomiting, bleeding, seizures) or altered mental status.”