Dear Dr Shah
My husband, aged 66, has had only one kidney since he was a teenager and his other kidney had to be removed after a rugby injury.  His egfr is hovering between 19 and 15. Two years ago it was 43. He has just has a renal biopsy and was diagnosed with Focal Segmental Glomeruloschlerosis and lots of signs of damage due to hypertension. He has peripheral neuropathy, proteinurea, fatigue and breathlessness, low Vitamin D and calcium levels, high phospate and PTH (211 pg/ml) levels. He has anaemia (haemoglobin 9.8) and low iron levels.  He has recently been put on phosphate binders, activated Vitamin D and iron tablets.  He is on 4 blood pressure tablets including a diuretic, and since the biopsy has been put back onto an ACE tablet (Prexum).  He was previously on an ACE tablet and taken off it due to potassium levels of 7.8mmol/l. He has CAD and 18 months ago had two stents inserted. Please explain FSGS to me and let me know what you think my husbands prognosis is, especially when he can expect to go on dialysis.  Many thanks for your time.


Thanks for asking my opinion on Allexperts.

Focal (fō-kəl) glomerulosclerosis (glō-měr'you-lō-sklə-rō'sĭs) describes scarring in the kidney. The scarring may be the result of an infection, or drug toxicity, or a disease that affects the entire body, like diabetes, HIV infection, sickle cell disease or lupus disease. Sometimes, there is no apparent associated disease or cause. There may be a genetic component in some people.

Glomerulosclerosis is a chronic disease, because the scarred glomeruli cannot be repaired. Treatment can slow the progression of kidney disease. Everyone is different in how they respond to treatment, any complications, and the rate of disease progression.

You should talk with your husband's doctor about his condition, because the progression of the disease depends on many factors. The underlying cause, his age, and his overall health affect his outcome.


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Dr. Shamik Shah, MD, DNB (Nephrology), ISN Fellow


I can answer all questions related to kidney diseases, hypertension, plasmapheresis and kidney transplantation. I am an Indian-Board certified Nephrologist. I was a post-Doctoral Scholar at the Division of Nephrology & Hypertension,Department of Medicine, University of California, San Diego. My area of interest is Critical care Nephrology and Acute Kidney Injury.

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Ten years as a Critical Care & Transplant Nephrologist

International Society of Nephrology
Indian Society of Nephrology
Indian Medical Association
European Renal Association

- Shah SH, Cerda J. Acute Tubular Necrosis; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4, pp. 191-198
- Shah SH, Cerda J. Management of Acute Kidney Injury; Lerma, Edgar V., Rosner, Mitchell eds. Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer ISBN 978-1-4614-4453-4
- Cerda J, Tolwani A, Shah SH, Ronco C. Continuous Renal Replacement Therapies in Modeling and Control of Dialysis Systems edited by Azar AT, Springer-Verlag, Heidelberg, Germany (In Press)
- Shah SH, Cerda J, Kellum JA. Acute Kidney Injury in Special Circumstances. John Kellum, Jorge Cerda, eds. Renal and Metabolic Disorders, Oxford University Press (In press)
- Shah SH, Mehta RL. “Anticoagulation in CRRT: Is Citrate better?”; Vineet Nayyar Ed. Critical Care Update 2009, Jaypee Brothers (In press)
- Shah SH, Mehta RL. “Non-dialytic management of acute kidney disease”; Evidence based Nephrology, BMJ, (In press)
- Shah SH, Mehta RL. “Epidemiology of Community-acquired AKI”; Ronco C, Bellomo R, Kellum J Eds. Critical Care Nephrology, Saunders. ISBN 1-4160-4252-0
- Abdeen O, Shah SH, Mehta RL; “Dialysis therapies in the surgical intensive care unit”; William Wilson, Christopher Grande, David Hoyt Eds. Trauma: Resuscitation, Anesthesia, and Critical Care, Informa Healthcare, NY 2007. ISBN 0-8247-2920-X
- Shah SH, Mehta RL. Acute kidney injury in critical care: time for a paradigm shift? Curr Opin Nephrol Hypertens. 2006 Nov;15(6):561-5.
- Shah, SH, Soroko S, Lischer E, Mehta RL. Delivered vs. Prescribed dose of Dialysis in Hospitalized Patients: Results of an Audit. J Am Soc Nephrol 17(Abstracts Issue): 2006, 107A.
- Shah SH et al “Biochemical Nutritional Parameters in Non-vegetarian and Vegetarian CAPD patients” Perit Dial Int 2001; 21 Suppl 2: S1-182

MBBS, MD (Internal Medicine), Diplomate of National board (Nephrology), ISN Fellow

Awards and Honors
Educational Ambassador of the International Society of Nephrology 2010
Fellowship of the International Society of Nephrology 2005.
Young Investigator Award by the International Society of Peritoneal Dialysis 2001

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