{"version":"1.0.0","segments":[{"startTime":0.09,"endTime":3.21,"body":"♪ (music) ♪"},{"startTime":3.21,"endTime":5.499,"body":"(Cathy) Hi,"},{"startTime":3.21,"endTime":5.499,"body":"welcome to \u003ci\u003eHarrison's Podclass,\u003c/i\u003e"},{"startTime":5.499,"endTime":8.679,"body":"where we discuss important concepts"},{"startTime":5.499,"endTime":8.679,"body":"in internal medicine."},{"startTime":8.679,"endTime":11.084,"body":"- I'm Cathy Handy."},{"startTime":8.679,"endTime":11.084,"body":"- (Charlie) And I'm Charlie Wiener"},{"startTime":11.084,"endTime":14.124,"body":"and we're coming to you"},{"startTime":11.084,"endTime":14.124,"body":"from the Johns Hopkins School of Medicine."},{"startTime":14.124,"endTime":15.698,"body":"♪ (music) ♪"},{"speaker":"Welcome to Episode 46","startTime":15.698,"endTime":19.654,"body":"A 50-Year-Old with Proteinuria."},{"speaker":"Welcome to Episode 46","startTime":19.654,"endTime":21.315,"body":"Cathy, here's the case."},{"speaker":"Welcome to Episode 46","startTime":21.315,"endTime":25.567,"body":"A 50-year-old, obese female"},{"speaker":"Welcome to Episode 46","startTime":21.315,"endTime":25.567,"body":"with a 5-year history of mild hypertension"},{"speaker":"Welcome to Episode 46","startTime":25.567,"endTime":28.522,"body":"that has been controlled"},{"speaker":"Welcome to Episode 46","startTime":25.567,"endTime":28.522,"body":"with a thiazide diuretic"},{"speaker":"Welcome to Episode 46","startTime":28.522,"endTime":32.055,"body":"is being evaluated because proteinuria"},{"speaker":"Welcome to Episode 46","startTime":28.522,"endTime":32.055,"body":"was noted on a urine dipstick"},{"speaker":"Welcome to Episode 46","startTime":32.055,"endTime":34.614,"body":"during her routine yearly medical visit."},{"speaker":"Welcome to Episode 46","startTime":34.614,"endTime":38.782,"body":"Her physical examination"},{"speaker":"Welcome to Episode 46","startTime":34.614,"endTime":38.782,"body":"discloses a height of 168 cm,"},{"speaker":"Welcome to Episode 46","startTime":38.782,"endTime":41.021,"body":"which is about 5 feet, 6 inches,"},{"speaker":"Welcome to Episode 46","startTime":41.021,"endTime":44.739,"body":"a weight of 91 kilograms,"},{"speaker":"Welcome to Episode 46","startTime":41.021,"endTime":44.739,"body":"or about 200 pounds,"},{"speaker":"Welcome to Episode 46","startTime":44.739,"endTime":47.207,"body":"a blood pressure of 130/80,"},{"speaker":"Welcome to Episode 46","startTime":47.207,"endTime":51.017,"body":"and she also is noted to have"},{"speaker":"Welcome to Episode 46","startTime":47.207,"endTime":51.017,"body":"an elevated jugular venous pressure,"},{"speaker":"Welcome to Episode 46","startTime":51.017,"endTime":54.164,"body":"a fourth heart sound,"},{"speaker":"Welcome to Episode 46","startTime":51.017,"endTime":54.164,"body":"and trace pedal edema."},{"speaker":"Welcome to Episode 46","startTime":54.164,"endTime":57.722,"body":"(Cathy) That translates to a BMI of 32,"},{"speaker":"Welcome to Episode 46","startTime":54.164,"endTime":57.722,"body":"so in the obese category,"},{"speaker":"Welcome to Episode 46","startTime":57.722,"endTime":59.654,"body":"which starts at a BMI of 30."},{"speaker":"Welcome to Episode 46","startTime":59.654,"endTime":61.988,"body":"And it also sounds like"},{"speaker":"Welcome to Episode 46","startTime":59.654,"endTime":61.988,"body":"she's pretty volume overloaded"},{"speaker":"Welcome to Episode 46","startTime":61.988,"endTime":63.416,"body":"with some heart failure."},{"speaker":"Welcome to Episode 46","startTime":63.416,"endTime":65.969,"body":"(Charlie) Okay, let me tell you"},{"speaker":"Welcome to Episode 46","startTime":63.416,"endTime":65.969,"body":"about her laboratory values."},{"speaker":"Welcome to Episode 46","startTime":65.969,"endTime":69.357,"body":"So, her serum creatinine is 1.2 mg/dL,"},{"speaker":"Welcome to Episode 46","startTime":69.357,"endTime":71.04,"body":"her BUN is 18,"},{"speaker":"Welcome to Episode 46","startTime":71.04,"endTime":74.281,"body":"her creatinine clearance is 87 mL/min."},{"speaker":"Welcome to Episode 46","startTime":74.281,"endTime":79.315,"body":"She has a urinalysis"},{"speaker":"Welcome to Episode 46","startTime":74.281,"endTime":79.315,"body":"which shows a spot pH of 5.0,"},{"speaker":"Welcome to Episode 46","startTime":79.315,"endTime":82.167,"body":"a specific gravity of 1.018,"},{"speaker":"Welcome to Episode 46","startTime":82.167,"endTime":84.759,"body":"a dipstick protein of 3+."},{"speaker":"Welcome to Episode 46","startTime":84.759,"endTime":86.681,"body":"Notably, there's no glucose,"},{"speaker":"Welcome to Episode 46","startTime":86.681,"endTime":90.935,"body":"and on microscopic examination"},{"speaker":"Welcome to Episode 46","startTime":86.681,"endTime":90.935,"body":"she has occasional course granular casts"},{"speaker":"Welcome to Episode 46","startTime":90.935,"endTime":93.234,"body":"and no red blood cells."},{"speaker":"Welcome to Episode 46","startTime":93.234,"endTime":96.192,"body":"She has a 24-hour urine collection,"},{"speaker":"Welcome to Episode 46","startTime":96.192,"endTime":101.42,"body":"which yields a protein excretion"},{"speaker":"Welcome to Episode 46","startTime":96.192,"endTime":101.42,"body":"of 5.9 g in 24 hours."},{"speaker":"Welcome to Episode 46","startTime":101.42,"endTime":104.08,"body":"(Cathy) Okay, so she has"},{"speaker":"Welcome to Episode 46","startTime":101.42,"endTime":104.08,"body":"nephrotic-range proteinuria,"},{"speaker":"Welcome to Episode 46","startTime":104.08,"endTime":107.707,"body":"the cut-off for that being over 3.5 g/day."},{"speaker":"Welcome to Episode 46","startTime":107.707,"endTime":109.432,"body":"She doesn't have any hematuria"},{"speaker":"Welcome to Episode 46","startTime":109.432,"endTime":111.683,"body":"or red blood cells"},{"speaker":"Welcome to Episode 46","startTime":109.432,"endTime":111.683,"body":"noted on the urinalysis"},{"speaker":"Welcome to Episode 46","startTime":111.683,"endTime":114.375,"body":"so we're dealing purely"},{"speaker":"Welcome to Episode 46","startTime":111.683,"endTime":114.375,"body":"with nephrotic-range proteinuria."},{"speaker":"Welcome to Episode 46","startTime":114.375,"endTime":117.188,"body":"(Charlie) Would you perform a renal biopsy"},{"speaker":"Welcome to Episode 46","startTime":114.375,"endTime":117.188,"body":"based on what you know now?"},{"speaker":"Welcome to Episode 46","startTime":117.188,"endTime":120.137,"body":"(Cathy) Probably."},{"speaker":"Welcome to Episode 46","startTime":117.188,"endTime":120.137,"body":"She doesn't have an underlying disease."},{"speaker":"Welcome to Episode 46","startTime":120.137,"endTime":122.349,"body":"We didn't hear anything about diabetes"},{"speaker":"Welcome to Episode 46","startTime":122.349,"endTime":124.767,"body":"that would obviously"},{"speaker":"Welcome to Episode 46","startTime":122.349,"endTime":124.767,"body":"be causing her proteinuria."},{"speaker":"Welcome to Episode 46","startTime":124.767,"endTime":127.773,"body":"And it sounds like this is new"},{"speaker":"Welcome to Episode 46","startTime":124.767,"endTime":127.773,"body":"compared to a year ago."},{"speaker":"Welcome to Episode 46","startTime":127.773,"endTime":130.413,"body":"The hypertension"},{"speaker":"Welcome to Episode 46","startTime":127.773,"endTime":130.413,"body":"that we did hear about she has--"},{"speaker":"Welcome to Episode 46","startTime":130.413,"endTime":133.156,"body":"typically, that doesn't cause"},{"speaker":"Welcome to Episode 46","startTime":130.413,"endTime":133.156,"body":"nephrotic-range proteinuria,"},{"speaker":"Welcome to Episode 46","startTime":133.156,"endTime":135.833,"body":"so in this case"},{"speaker":"Welcome to Episode 46","startTime":133.156,"endTime":135.833,"body":"I would refer for a biopsy."},{"speaker":"Welcome to Episode 46","startTime":135.833,"endTime":140.093,"body":"(Charlie) Okay, so the question states"},{"speaker":"Welcome to Episode 46","startTime":135.833,"endTime":140.093,"body":"that she undergoes a renal biopsy,"},{"speaker":"Welcome to Episode 46","startTime":140.093,"endTime":143.008,"body":"which demonstrates"},{"speaker":"Welcome to Episode 46","startTime":140.093,"endTime":143.008,"body":"that 60% of the glomeruli,"},{"speaker":"Welcome to Episode 46","startTime":143.008,"endTime":145.435,"body":"mostly in the corticomedullary junction,"},{"speaker":"Welcome to Episode 46","startTime":145.435,"endTime":148.412,"body":"have segmental scarring"},{"speaker":"Welcome to Episode 46","startTime":145.435,"endTime":148.412,"body":"by light microscopy."},{"speaker":"Welcome to Episode 46","startTime":148.412,"endTime":151.685,"body":"The remainder of the glomeruli"},{"speaker":"Welcome to Episode 46","startTime":148.412,"endTime":151.685,"body":"appear unremarkable."},{"speaker":"Welcome to Episode 46","startTime":151.685,"endTime":155.37,"body":"Based on this finding,"},{"speaker":"Welcome to Episode 46","startTime":151.685,"endTime":155.37,"body":"what is the most likely diagnosis?"},{"speaker":"Welcome to Episode 46","startTime":155.37,"endTime":160.026,"body":"Option A"},{"speaker":"Welcome to Episode 46","startTime":155.37,"endTime":160.026,"body":"is focal segmental glomerulosclerosis;"},{"speaker":"Welcome to Episode 46","startTime":160.026,"endTime":164.084,"body":"option B is hypertensive nephrosclerosis;"},{"speaker":"Welcome to Episode 46","startTime":164.084,"endTime":167.384,"body":"option C is Minimal Change Disease;"},{"speaker":"Welcome to Episode 46","startTime":167.384,"endTime":171.135,"body":"option D"},{"speaker":"Welcome to Episode 46","startTime":167.384,"endTime":171.135,"body":"is membranous glomerular nephropathy;"},{"speaker":"Welcome to Episode 46","startTime":171.135,"endTime":174.818,"body":"and option E"},{"speaker":"Welcome to Episode 46","startTime":171.135,"endTime":174.818,"body":"is crescentic glomerulonephritis."},{"speaker":"Welcome to Episode 46","startTime":174.818,"endTime":178.784,"body":"(Cathy) So, the option here"},{"speaker":"Welcome to Episode 46","startTime":174.818,"endTime":178.784,"body":"is Option A, which is FSGS."},{"speaker":"Welcome to Episode 46","startTime":178.784,"endTime":181.98,"body":"Now, the characteristic pattern"},{"speaker":"Welcome to Episode 46","startTime":178.784,"endTime":181.98,"body":"that you see is what you mentioned."},{"speaker":"Welcome to Episode 46","startTime":181.98,"endTime":185.765,"body":"So, it's focal, meaning that"},{"speaker":"Welcome to Episode 46","startTime":181.98,"endTime":185.765,"body":"not all the glomeruli are involved,"},{"speaker":"Welcome to Episode 46","startTime":185.765,"endTime":186.97,"body":"and it's also segmental,"},{"speaker":"Welcome to Episode 46","startTime":186.97,"endTime":190.382,"body":"so that means"},{"speaker":"Welcome to Episode 46","startTime":186.97,"endTime":190.382,"body":"that the entire glomerulus isn't involved."},{"speaker":"Welcome to Episode 46","startTime":190.383,"endTime":192.909,"body":"The history and laboratory features"},{"speaker":"Welcome to Episode 46","startTime":190.383,"endTime":192.909,"body":"that you mentioned"},{"speaker":"Welcome to Episode 46","startTime":192.909,"endTime":194.673,"body":"are also consistent with this lesion."},{"speaker":"Welcome to Episode 46","startTime":194.673,"endTime":196.534,"body":"There's some associated hypertension,"},{"speaker":"Welcome to Episode 46","startTime":196.534,"endTime":198.741,"body":"there's a decrease"},{"speaker":"Welcome to Episode 46","startTime":196.534,"endTime":198.741,"body":"in her creatinine clearance,"},{"speaker":"Welcome to Episode 46","startTime":198.741,"endTime":201.136,"body":"and a relatively inactive urine sediment."},{"speaker":"Welcome to Episode 46","startTime":201.136,"endTime":202.391,"body":"(Charlie) What's the etiology?"},{"speaker":"Welcome to Episode 46","startTime":202.391,"endTime":204.97,"body":"What do you think"},{"speaker":"Welcome to Episode 46","startTime":202.391,"endTime":204.97,"body":"about the etiologies of FSGS?"},{"speaker":"Welcome to Episode 46","startTime":204.97,"endTime":208.411,"body":"(Cathy) You can have primary"},{"speaker":"Welcome to Episode 46","startTime":204.97,"endTime":208.411,"body":"or secondary causes of FSGS,"},{"speaker":"Welcome to Episode 46","startTime":208.411,"endTime":210.711,"body":"and there are a large number"},{"speaker":"Welcome to Episode 46","startTime":208.411,"endTime":210.711,"body":"of secondary causes."},{"speaker":"Welcome to Episode 46","startTime":210.711,"endTime":214.793,"body":"So, you have to think about"},{"speaker":"Welcome to Episode 46","startTime":210.711,"endTime":214.793,"body":"viral infections, such as HIV or hepatitis."},{"speaker":"Welcome to Episode 46","startTime":214.793,"endTime":216.963,"body":"Hypertension can lead to FSGS."},{"speaker":"Welcome to Episode 46","startTime":216.963,"endTime":220.065,"body":"Certain drugs,"},{"speaker":"Welcome to Episode 46","startTime":216.963,"endTime":220.065,"body":"like heroin or bisphosphonates,"},{"speaker":"Welcome to Episode 46","startTime":220.065,"endTime":223.322,"body":"and sickle cell disease"},{"speaker":"Welcome to Episode 46","startTime":220.065,"endTime":223.322,"body":"can also lead to FSGS."},{"speaker":"Welcome to Episode 46","startTime":223.322,"endTime":226.654,"body":"Now, there are other less common causes"},{"speaker":"Welcome to Episode 46","startTime":223.322,"endTime":226.654,"body":"and even genetic causes,"},{"speaker":"Welcome to Episode 46","startTime":226.654,"endTime":229.162,"body":"but if the secondary causes are eliminated"},{"speaker":"Welcome to Episode 46","startTime":229.162,"endTime":232.735,"body":"then the remaining patients"},{"speaker":"Welcome to Episode 46","startTime":229.162,"endTime":232.735,"body":"are considered to have primary FSGS."},{"speaker":"Welcome to Episode 46","startTime":232.735,"endTime":234.186,"body":"(Charlie) How common is it?"},{"speaker":"Welcome to Episode 46","startTime":234.186,"endTime":238.126,"body":"(Cathy) The prevalence is increasing,"},{"speaker":"Welcome to Episode 46","startTime":234.186,"endTime":238.126,"body":"and it's more common in African-Americans."},{"speaker":"Welcome to Episode 46","startTime":238.126,"endTime":242.206,"body":"It now represents up to one third"},{"speaker":"Welcome to Episode 46","startTime":238.126,"endTime":242.206,"body":"of cases of nephrotic syndrome."},{"speaker":"Welcome to Episode 46","startTime":242.206,"endTime":244.823,"body":"(Charlie) What's the expected outcome"},{"speaker":"Welcome to Episode 46","startTime":242.206,"endTime":244.823,"body":"for patients like this?"},{"speaker":"Welcome to Episode 46","startTime":244.823,"endTime":246.957,"body":"(Cathy) It rarely remits spontaneously,"},{"speaker":"Welcome to Episode 46","startTime":246.957,"endTime":249.973,"body":"but you can have treatment-induced"},{"speaker":"Welcome to Episode 46","startTime":246.957,"endTime":249.973,"body":"remission of the proteinuria,"},{"speaker":"Welcome to Episode 46","startTime":249.973,"endTime":252.918,"body":"and that would"},{"speaker":"Welcome to Episode 46","startTime":249.973,"endTime":252.918,"body":"significantly improve her prognosis."},{"speaker":"Welcome to Episode 46","startTime":252.918,"endTime":255.245,"body":"Treatment of patients with primary FSGS"},{"speaker":"Welcome to Episode 46","startTime":255.245,"endTime":258.356,"body":"should include inhibitors"},{"speaker":"Welcome to Episode 46","startTime":255.245,"endTime":258.356,"body":"of the renin-angiotensin system"},{"speaker":"Welcome to Episode 46","startTime":258.356,"endTime":260.239,"body":"and the treatment of secondary FSGS"},{"speaker":"Welcome to Episode 46","startTime":260.239,"endTime":262.501,"body":"typically involves"},{"speaker":"Welcome to Episode 46","startTime":260.239,"endTime":262.501,"body":"treating the underlying cause"},{"speaker":"Welcome to Episode 46","startTime":262.501,"endTime":264.396,"body":"and controlling the proteinuria."},{"speaker":"Welcome to Episode 46","startTime":264.396,"endTime":267.773,"body":"There's no role for steroids"},{"speaker":"Welcome to Episode 46","startTime":264.396,"endTime":267.773,"body":"or other immunosuppressive agents"},{"speaker":"Welcome to Episode 46","startTime":267.773,"endTime":269.423,"body":"in secondary FSGS."},{"speaker":"Welcome to Episode 46","startTime":269.423,"endTime":271.384,"body":"(Charlie) So,"},{"speaker":"Welcome to Episode 46","startTime":269.423,"endTime":271.384,"body":"the central aspect to treatment"},{"speaker":"Welcome to Episode 46","startTime":271.384,"endTime":274.198,"body":"is with ACE inhibitors"},{"speaker":"Welcome to Episode 46","startTime":271.384,"endTime":274.198,"body":"or ARBs, it sounds like."},{"speaker":"Welcome to Episode 46","startTime":274.198,"endTime":276.224,"body":"(Cathy) Yes, to control the proteinuria."},{"speaker":"Welcome to Episode 46","startTime":276.224,"endTime":279.459,"body":"And there are risk factors"},{"speaker":"Welcome to Episode 46","startTime":276.224,"endTime":279.459,"body":"that are associated with poorer outcomes,"},{"speaker":"Welcome to Episode 46","startTime":279.459,"endTime":282.621,"body":"so that would include, once you get"},{"speaker":"Welcome to Episode 46","startTime":279.459,"endTime":282.621,"body":"to the nephrotic-range proteinuria,"},{"speaker":"Welcome to Episode 46","startTime":282.621,"endTime":285.306,"body":"African-American race,"},{"speaker":"Welcome to Episode 46","startTime":282.621,"endTime":285.306,"body":"and renal insufficiency."},{"speaker":"Welcome to Episode 46","startTime":285.306,"endTime":288.799,"body":"And up to half of those patients"},{"speaker":"Welcome to Episode 46","startTime":285.306,"endTime":288.799,"body":"will reach frank renal failure"},{"speaker":"Welcome to Episode 46","startTime":288.799,"endTime":291.255,"body":"in six to eight years after diagnosis."},{"speaker":"Welcome to Episode 46","startTime":291.255,"endTime":292.826,"body":"(Charlie) What about the other options?"},{"speaker":"Welcome to Episode 46","startTime":292.826,"endTime":294.643,"body":"What would you expect to see"},{"speaker":"Welcome to Episode 46","startTime":292.826,"endTime":294.643,"body":"on kidney biopsy"},{"speaker":"Welcome to Episode 46","startTime":294.643,"endTime":297.604,"body":"if a renal disease was due"},{"speaker":"Welcome to Episode 46","startTime":294.643,"endTime":297.604,"body":"to one of the other causes?"},{"speaker":"Welcome to Episode 46","startTime":297.604,"endTime":300.653,"body":"(Cathy) Option B talks about"},{"speaker":"Welcome to Episode 46","startTime":297.604,"endTime":300.653,"body":"hypertensive nephrosclerosis."},{"speaker":"Welcome to Episode 46","startTime":300.653,"endTime":303.323,"body":"And this exhibits"},{"speaker":"Welcome to Episode 46","startTime":300.653,"endTime":303.323,"body":"more prominent vascular changes"},{"speaker":"Welcome to Episode 46","startTime":303.323,"endTime":306.533,"body":"and patchy ischemic,"},{"speaker":"Welcome to Episode 46","startTime":303.323,"endTime":306.533,"body":"totally sclerosed glomeruli."},{"speaker":"Welcome to Episode 46","startTime":306.533,"endTime":309.779,"body":"In addition,"},{"speaker":"Welcome to Episode 46","startTime":306.533,"endTime":309.779,"body":"you also don't see nephrosclerosis"},{"speaker":"Welcome to Episode 46","startTime":309.779,"endTime":313.024,"body":"associated with"},{"speaker":"Welcome to Episode 46","startTime":309.779,"endTime":313.024,"body":"nephrotic-range proteinuria, usually."},{"speaker":"Welcome to Episode 46","startTime":313.024,"endTime":315.324,"body":"Option C mentions Minimal Change Disease,"},{"speaker":"Welcome to Episode 46","startTime":315.324,"endTime":317.821,"body":"and that's usually associated"},{"speaker":"Welcome to Episode 46","startTime":315.324,"endTime":317.821,"body":"with symptomatic edema,"},{"speaker":"Welcome to Episode 46","startTime":317.821,"endTime":321.153,"body":"but normal-appearing glomeruli"},{"speaker":"Welcome to Episode 46","startTime":317.821,"endTime":321.153,"body":"on light microscopy."},{"speaker":"Welcome to Episode 46","startTime":321.153,"endTime":323.955,"body":"Option D talks about"},{"speaker":"Welcome to Episode 46","startTime":321.153,"endTime":323.955,"body":"membranous nephropathy,"},{"speaker":"Welcome to Episode 46","startTime":323.955,"endTime":328.062,"body":"which the patient's presentation"},{"speaker":"Welcome to Episode 46","startTime":323.955,"endTime":328.062,"body":"is consistent, but the biopsy is not."},{"speaker":"Welcome to Episode 46","startTime":328.062,"endTime":330.442,"body":"So, in membranous glomerular nephropathy,"},{"speaker":"Welcome to Episode 46","startTime":330.442,"endTime":335.093,"body":"all glomeruli are uniformly involved"},{"speaker":"Welcome to Episode 46","startTime":330.442,"endTime":335.093,"body":"with subepithelial dense deposits."},{"speaker":"Welcome to Episode 46","startTime":335.093,"endTime":337.697,"body":"And Option E is not supported by this case"},{"speaker":"Welcome to Episode 46","startTime":337.697,"endTime":341.021,"body":"because there are no features"},{"speaker":"Welcome to Episode 46","startTime":337.697,"endTime":341.021,"body":"of crescentic glomerular nephritis here."},{"speaker":"Welcome to Episode 46","startTime":341.021,"endTime":343.099,"body":"(Charlie) Okay,"},{"speaker":"Welcome to Episode 46","startTime":341.021,"endTime":343.099,"body":"so the teaching point in this case"},{"speaker":"Welcome to Episode 46","startTime":343.099,"endTime":347.497,"body":"is that FSGS,"},{"speaker":"Welcome to Episode 46","startTime":343.099,"endTime":347.497,"body":"or focal segmental glomerulosclerosis,"},{"speaker":"Welcome to Episode 46","startTime":347.497,"endTime":350.344,"body":"is one of the major causes"},{"speaker":"Welcome to Episode 46","startTime":347.497,"endTime":350.344,"body":"of proteinuria in adults."},{"speaker":"Welcome to Episode 46","startTime":350.344,"endTime":352.735,"body":"On renal biopsy"},{"speaker":"Welcome to Episode 46","startTime":350.344,"endTime":352.735,"body":"you'll see a characteristic pattern"},{"speaker":"Welcome to Episode 46","startTime":352.735,"endTime":355.823,"body":"of focal and segmental"},{"speaker":"Welcome to Episode 46","startTime":352.735,"endTime":355.823,"body":"glomerular scarring."},{"speaker":"Welcome to Episode 46","startTime":355.823,"endTime":360.293,"body":"There are a bunch of primary disorders"},{"speaker":"Welcome to Episode 46","startTime":355.823,"endTime":360.293,"body":"that can lead to secondary FSGS,"},{"speaker":"Welcome to Episode 46","startTime":360.293,"endTime":362.359,"body":"or, in the absence"},{"speaker":"Welcome to Episode 46","startTime":360.293,"endTime":362.359,"body":"of a precipitating cause,"},{"speaker":"Welcome to Episode 46","startTime":362.359,"endTime":363.934,"body":"it can be primary."},{"speaker":"Welcome to Episode 46","startTime":363.934,"endTime":366.501,"body":"Treatment centers around"},{"speaker":"Welcome to Episode 46","startTime":363.934,"endTime":366.501,"body":"treating the underlying cause,"},{"speaker":"Welcome to Episode 46","startTime":366.501,"endTime":367.491,"body":"when there is one,"},{"speaker":"Welcome to Episode 46","startTime":367.491,"endTime":371.297,"body":"and treating the proteinuria"},{"speaker":"Welcome to Episode 46","startTime":367.491,"endTime":371.297,"body":"with ACE inhibitors and ARBs."},{"speaker":"Welcome to Episode 46","startTime":371.297,"endTime":373.631,"body":"(Cathy) And to learn more about this"},{"speaker":"Welcome to Episode 46","startTime":371.297,"endTime":373.631,"body":"you can read"},{"speaker":"Welcome to Episode 46","startTime":373.631,"endTime":376.202,"body":"in \u003ci\u003eHarrison's\u003c/i\u003e chapter on Renal Disorders."},{"speaker":"Welcome to Episode 46","startTime":376.202,"endTime":378.825,"body":"♪ (music) ♪"}]}