Enhanced renal perfusion improves function in severe nephrosis with focal segmental glomerulosclerosis

Summary: Fourteen cases of severe steroid-resistant nephrosis with focal segmental glomerulosclerosis were identified by the moderate to severe impairment of glomerular function. Symptoms included low glomerular filtration rate, ultrafiltration coefficient and increased intraglomerular hydrostatic pressure, tubular dysfunction including a defect in transporting solute, which was reflected by increasing fractional excretion of filtered solutes, in concentrating and acidifying the urine, and vascular dysfunction including marked elevation of renal arteriolar resistances and inversely severe reduction of renal plasma flow and peritubular capillary blood flow.
Of these 14 nephrotics, eight patients were randomly treated with prednisolone, cyclophosphamide and antihypertensive agents, namely reserpine, hydralazine or prazosin, and the other six patients who had previously been resistant to prednisolone and cyclophosphamide were treated with an enhanced-renal-perfusion formula that consisted of a combination of antiplatelet agents, calcium channel blockers, angiotensin-converting-enzyme inhibitors, anticoagulant and prednisolone.
After follow-up of 62 months, all eight patients were refractory to the conventional treatment, showing persistent proteinuria with a progressive deterioration of renal function entering end-stage renal disease. In contrast, five of the six patients under the enhanced-renal-perfusion formula gradually improved their renal functions and survived after 82 months of follow-up. the remaining patient, who did not improve, died of sepsis.