. 2017 Feb 27;12(3):502–517. doi: 10.2215/CJN.05960616

Table 5.

Treatment recommendations for adults with FSGS

Setting	Therapy	Comment
Nephrotic forms of primary FSGS,^a APOL1 FSGS, certain steroid-sensitive genetic forms of FSGS	Prednisone, initially daily or alternate days^a	Alternate for patients at high risk for steroid complications: calcineurin inhibitors^a
Steroid-resistant FSGS with nephrotic syndrome^a	Calcineurin inhibitor^a (cyclosporin and possibly, tacrolimus)
Refractory FSGS with nephrotic syndrome^a	Mycophenolate mofetil plus high-dose dexamethasone^a
All forms of FSGS with subnephrotic proteinuria	ACE inhibitor and angiotensin receptor blocker; dietary sodium restriction	Thiazide diuretic may potentiate the antiproteinuric of RAAS antagonism

Therapy doses are in ref. 46. Cyclosporin has been shown effective in randomized, controlled trials, whereas tacrolimus has not. In the nosology presented here, these recommendations would apply, when nephrotic syndrome is present, to primary FSGS, APOL1 FSGS, and certain rare forms of genetic FSGS that may be steroid sensitive. ACE, angiotensin-converting enzyme; RAAS, renin-angiotensin-aldosterone system.

Recommendations from the Kidney Disease Improving Outcomes Global initiatives for idiopathic FSGS with nephrotic syndrome are extended here to other forms of FSGS as shown.