Correction of peritubular capillary flow reduction with vasodilators restores function in focal segmental glomerulosclerotic nephrosis.

Due to the previously therapeutic failure in treating eleven focal segmental glomerulosis (FSGS) nephrotic patients (group I) with prednisolone, cyclophosphamide and antihypertensive agents (reserpine, hydralazine or prazosin) who all entered end-stage renal disease, we prospectively evaluate 18 FSGS nephrotic patients who have been treated with combined formula consisting of ACEI, AIIRA, CCB, antiplatelet+/-heparin; group II. All the patients were subject to renal function studies namely creatinine clearance, fractional excretion of magnesium (FE Mg) and intrarenal hemodynamics. Treatment outcome of patients in group II was comparatively assessed before and after therapy. Clinical profiles were comparatively matched between groups I and II. The intrarenal hemodynamic study in all nephrotic patients revealed hemodynamic maladjustment characterized by preferential constriction at the efferent arteriole. Such constriction induced intraglomerular hypertension and exaggeratedly reduced peritubular capillary flow (PTCF). Following treatment with combined formula (group II), reductions in efferent arteriolar resistance and intraglomerular hydrostatic pressure were observed in conjunction with the increases in PTCF and glomerular filtration rate in all 18 patients. Correction of hemodynamic maladjustment with combined formula effectively restores renal function and thereby prevents the renal disease progression in FSGS nephrosis.