Overview
Glomerular hyperfiltration (GHF) in the context of focal segmental glomerulosclerosis (FSGS) refers to an increased glomerular filtration rate (GFR) disproportionate to the nephron mass, often associated with podocyte injury and proteinuria 1.Diagnosis
Elevated GFR in the presence of normal or near-normal renal function
Presence of proteinuria (typically >1 g/day)
Renal biopsy showing characteristic FSGS lesions
Exclusion of other causes of nephrotic syndrome and hyperfiltration states 1Management
First-line treatments: Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to reduce proteinuria and potentially slow disease progression 1
Adjunctive therapies: Corticosteroids and calcineurin inhibitors (e.g., cyclosporine, tacrolimus) for refractory cases 1Special Populations
Comorbidities: No specific data provided in the abstracts regarding the impact of comorbidities like diabetes or cardiovascular disease on FSGS with GHF 1Key Recommendations
Monitor and manage lipid profiles, particularly focusing on small dense LDL cholesterol (sdLDL-C) to LDL-C ratio, as higher ratios are independently associated with GHF 1 (Evidence: Moderate)
Initiate ACE inhibitors or ARBs to control proteinuria and potentially mitigate cardiovascular risks associated with GHF 1 (Evidence: Moderate)
Consider adjunctive immunosuppressive therapy with corticosteroids or calcineurin inhibitors for patients with persistent proteinuria despite optimal medical management 1 (Evidence: Weak)References
1 Morimoto N, Yamamoto Y, Toragai R, Kuroshima T, Watanabe Y, Ito Y et al.. Higher Small Dense LDL Cholesterol to LDL Cholesterol Ratio is Associated with Glomerular Hyperfiltration in Adults without Diabetes. Journal of atherosclerosis and thrombosis 2026. link