Steroid-Sensitive Nephrotic Syndrome and Anti-Nephrin Antibodies: Pathogenic Insights and Therapeutic Opportunities

Steroid-sensitive nephrotic syndrome (SSNS) encompasses a heterogeneous spectrum of podocytopathies, ranging from classical T-cell-mediated forms to those with an autoimmune component. Anti-nephrin autoantibodies have recently emerged as serological markers in a subset of immune-mediated podocytopathies, particularly in minimal change disease (MCD), primary FSGS, and immunoresponsive SSNS/SDNS. Although they correlate with disease activity and remission in selected cases, their sensitivity remains variable and assay standardization is still lacking. Rituximab shows the greatest efficacy in steroid-dependent or frequently relapsing forms, particularly in primary MCD/FSGS, while demonstrating limited benefit in genetic steroid-resistant disease. Overall, anti-nephrin autoantibodies should be regarded as promising yet still emerging biomarkers, potentially useful for refining phenotypic classification and supporting more personalized therapeutic strategies. Prospective studies and standardized detection protocols will be necessary before their integration into routine clinical practice can be recommended.