A Kidney Disease Mystery: Wha... Video Transcript

Participants

Lisa Clark , Jai Radhakrish MD, MRCP (, Leonard Stern MD, Rakhi Khanna DO

Summary

Many cases of kidney disease in the United States are linked to serious medical conditions like high blood pressure or diabetes, but there some forms of kidney disease that have no known cause. FSGS, is one of the rare kidney diseases that cause damage to the filtering units called the glomeruli in the kidney. Join our panelists for an in-depth look at this condition.

Webcast Transcript

LISA CLARK: I'm Lisa Clark. Welcome, and thank you for joining us for this webcast. Many cases of kidney disease in the United States are linked to other serious medical conditions like high blood pressure or diabetes, but there are other forms of kidney disease which may strike with no known cause and have serious repercussions. For the next few minutes, we're going to take a closer look at one of these diseases called focal segmental glomerulosclerosis, or in shorter form, thank goodness, FSGS.

Joining our discussion this evening, Dr. Leonard Stern, immediately to my left, and Dr. Jai Radhakrishnan. Welcome to both of you and thank you for being here.

I am going to stick with the abbreviation for this, FSGS, and Len, I'll ask you to describe what this disease is.

LEONARD STERN, MD:/ Well, the kidney consists of many parts. One of them is called the glomerulus, which is the main filtering part of the kidney. This illness attacks the glomerulus, the filtering function of the kidney. There are two forms. One is an inflammatory form, and one is a relatively bland form. They both produce the injury to the filtering part of the kidney where protein leaks into the urine, and the consequences of protein leaking into the urine over time is that the protein acts as a toxin which injures the remaining parts of the nephrons. So this, once it's initiated, is progressive and indolent in some patients, rapid in others, but will eventually result in kidney failure requiring dialysis or transplant.

LISA CLARK: People may actually know a little bit about this because two pro basketball players were recently diagnosed with FSGS -- Alonso Mourning and Sean Elliott. When you have a big-name celebrity who is diagnosed with a disease, does that immediately lead to a lot more interest and study on the disease?

JAI RADHAKRISHNAN, MD: It's usual, but as nephrologists, we see this every day. It's nothing unusual for us. That I'll tell you.

LISA CLARK: How common is it?

JAI RADHAKRISHNAN, MD: If you look at diseases that cause kidney failure, it's not common, but when you look at kidneys that cause protein to be leaked to the urine, it is probably one of the most common diagnoses that you can find in what we call nephrotic syndrome, which is a syndrome where you lose a lot of protein, you swell up, and the protein in your blood drops. It's probably the most common cause of nephrotic syndrome in certain populations.

LISA CLARK: Len, who is most at risk for developing this disease?

LEONARD STERN, MD:/ Well, there are a variety of things. It largely affects males, African Americans more so than white Americans. It has some association with drug use, illicit drug use. There is some association with HIV and AIDS, but on the other hand there is an association with obesity, with urinary tract infections and mechanical reflux of urine from the bladder into the ureters. But reasonably speaking, when an illness is associated with so many different things, the reason for that is that we don't know the cause.

The issue with this illness is that it is a relentless disorder unless it's treated, and the difficulties with the illness of the protein leaking in the urine, that's really the target of the therapy. Since we don't understand the primary cause in the vast majority of patients, all we do is we treat the features of the illness, and those might be related to the high blood pressure that the illness causes, and we directly attack the protein leaking into the urine by a variety of means to try to eliminate that.