American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the primary treatment for focal segmental glomerulosclerosis (FSGS) during initial presentation?

Glucocorticoids
Antibiotics
Calcium channel blockers
Beta-blockers

The correct answer is: Glucocorticoids

The primary treatment for focal segmental glomerulosclerosis (FSGS) during its initial presentation is glucocorticoids. FSGS is a nephrotic syndrome characterized by proteinuria, hypoalbuminemia, and edema, often associated with glomerular injury. The immunosuppressive properties of glucocorticoids can help reduce inflammation in the kidneys, decrease proteinuria, and promote recovery of renal function. Glucocorticoids are particularly effective in managing primary (idiopathic) FSGS, where the condition is thought to be related to an autoimmune or inflammatory process. By administering glucocorticoids early in the treatment regimen, clinicians aim to control the disease's progression and prevent further kidney damage. Other medications such as antibiotics, calcium channel blockers, and beta-blockers do not target the underlying pathophysiology of FSGS. Antibiotics are typically reserved for treating infections rather than autoimmune glomerular diseases. Calcium channel blockers and beta-blockers are primarily used for managing hypertension and have no direct role in treating FSGS. Thus, glucocorticoids are the cornerstone of initial therapy for this condition.