DILEMMA OF FOCAL SEGMENTAL GLOMERULAR SCLEROSIS

Focal segmental glomerulosclerosis is one of the most serious acquired chronic renal disorders of children [1]. The lesion, originally descr ibed in 1957 by Rich as ''a hitherto undescribed vulnerability of juxt amedullary glomeruli in lipoid nephrosis'' [2], has become a therapeut ic challenge to nephrologists in general and pediatric nephrologists i n particular, since the lesion is more commonly seen in children and i nvariably leads to end-stage renal disease. Currently no specific ther apy is available to control the proteinuria, and it has been shown tha t the progression of the disease is related to the profusion of protei nuria [3]. In view of the seriousness of the disease controversial tre atments are now being proposed to control the proteinuria. This review will deal with the magnitude of the problem, current therapeutic moda lities, the pathogenesis of the disease process, possible therapeutic interventions and their antecedent complications. The review will also provide the design of a clinical trial organized to determine if two potential modalities of therapy are comparable in efficacy and/or seri ous side effects.