This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Focal Segmental Glomerulosclerosis (FSGS) is a serious kidney disease that often leads to kidney failure and need for kidney machine treatment. There is no standard therapy for FSGS and the best medication regiment for treatment of this disease is still unknown. Patients are usually treated with prednisone, but majority fail to achieve any benefit. The purpose of the study is to determine if therapy with Mycophenolate Mofetil (MMF) and Dexamethasone is more effective in decreasing proteinuria (protein in the urine) in patients with FSGS compared with the therapy with cyclosporine (CYA). The goals of the study are to decrease protein excretion.Therapy with CYA has been used by many kidney specialists to treat patients with FSGS in attempt to decrease urine protein excretion and protect kidney function. However, CYA is not always successful in controlling this disease and has known side effects. The other study treatment to be tested consists of a combination of medicines MMF and dexamethasone. MMF has been used in transplant patients and in small numbers of patients with FSGS. Dexamethasone has also been used in a small number of patients with FSGS. The reports from use of MMF or Dexamethasone suggest that a decrease in proteinuria may be observed in patients with FSGS. No major side effects were reported. The drugs have not been compared to each other in a large trial and additional research is needed to identify the best option. Due to these facts, the investigators have to consider these drugs as investigational in the treatment of FSGS although they have been approved for treatment of many other kidney diseases. All study patients will be treated with low dose prednisone every other day and the blood pressure medicine lisinopril. The medicine losartan can be used if you cannot tolerate lisinopril.In addition to finding the most optimal drug therapy for FSGS , research to identify genes that cause or contribute to a disease or trait is an increasingly important way to try to understand the role of genes in human disease. This study, will also collect tissue, cell or blood samples from patients because they want to save such biological samples for future research.
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