Recent progress in the pathophysiology and treatment of FSGS recurrence

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome and end-stage renal disease.
• FSGS recurrence post-kidney transplantation affects approximately 25% of patients, jeopardizing graft survival.
• Pathogenesis may involve T and B cell abnormalities or circulating permeability factors damaging podocytes.

Purpose of the Study:

• To review the current understanding of FSGS pathogenesis and recurrence.
• To evaluate existing and emerging treatment strategies for FSGS recurrence.
• To highlight the unmet need for effective therapies in FSGS.

Main Methods:

• Literature review of experimental and clinical studies on FSGS.
• Analysis of data on T and B cell roles in FSGS pathogenesis.
• Evaluation of treatment outcomes for plasmapheresis, cyclosporine, antiproteinuric agents, and rituximab.

Main Results:

• Current treatments like plasmapheresis and cyclosporine have limitations for FSGS recurrence.
• Antiproteinuric agents are underutilized despite evidence of slowing renal decline.
• Rituximab shows promise but requires further investigation for safety and efficacy.

Conclusions:

• FSGS recurrence remains a significant challenge in kidney transplantation.
• Novel therapeutic approaches are urgently needed to improve long-term allograft survival.
• Targeting immune pathways and optimizing proteinuria management are key areas for future research.