As with MCD, the hallmark of FSGS is the presence of proteinuria, which can vary in severity from only 1 to 2 g/day to more than 10 g/day. Unlike MCD, at presentation, patients with FSGS are more prone to have concomitant microscopic hematuria (up to 50% of the time), hypertension (33% of the time), and a depressed glomerular filtration rate leading to elevated serum creatinine levels (33% of the time). Typically, patients with heavy proteinuria present clinically with signs and symptoms of the nephrotic syndrome (see earlier). As with MCD, serum complement levels are normal.
Information from the National Library of Medicine
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The uptake, by skeletal muscle, accounts for >70% of the glucose removal from the serum in humans. Therefore, it should be obvious that this event is extremely important for overall glucose homeostasis, keeping in mind, of course, that glucose uptake by cardiac muscle and adipocytes cannot be excluded from consideration. An important fact related to skeletal muscle glucose uptake is that this process is markedly impaired in individuals with type 2 diabetes. The uptake of glucose increases dramatically in response to stress (such as ischemia) and exercise and is stimulated by insulin-induced recruitment of glucose transporters to the plasma membrane, primarily GLUT4. Insulin-independent recruitment of glucose transporters also occurs in skeletal muscle in response to contraction (exercise). The activation of AMPK plays an important, albeit not an exclusive, role in the induction of GLUT4 recruitment to the plasma membrane. In fact, the ability of AMPK to stimulate GLUT4 translocation to the plasma membrane in skeletal muscle occurs via a mechanism distinct from that stimulated by insulin since together insulin and AMPK effects are additive. AMPK activation also results in increased expression of the GLUT4 gene through enhanced binding of the transcription factor MEF-2 (myocyte enhancer factor-2) to promoters in the GLUT4 gene. In addition, there is some demonstration that AMPK may regulate glucose transport through GLUT1. Increased glucose uptake will result in an increase in glycolysis and ATP production.