AI Research Answer
FSGS treatment
3 cited papers · March 31, 2026 · Powered by Researchly AI
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TL;DR
Focal segmental glomerulosclerosis (FSGS) is a leading cause of kidney disease worldwide and one of the most common glomerular causes leading to end-stage kidne…
Focal segmental glomerulosclerosis (FSGS) is a leading cause of kidney disease worldwide and one of the most common glomerular causes leading to end-stage kidney disease (ESKD).1Amir et al. (2020)2
The management of FSGS remains a therapeutic challenge due to intolerance or resistance to current immunomodulatory treatments. Rupesh et al. (2020)
- Primary FSGS — Thought to be caused by circulating permeability factors leading to podocyte foot process effacement, usually presenting with nephrotic syndrome and responsive to immunosuppression.
- Extracorporeal Therapies — Includes plasma exchange, immunoadsorption, and low-density lipoprotein apheresis; shown to have potential beneficial outcomes in drug-resistant and recurrent FSGS patients.
- Anti-TGF-β Therapy (Fresolimumab) — A human monoclonal antibody inactivating all forms of TGF-β, evaluated in treatment-resistant primary FSGS. Trachtman et al. (2011)
1
Focal Segmental Glomerulosclerosis.Rosenberg Avi Z, Kopp Jeffrey B2017Clinical journal of the American Society of Nephrology : CJASN
View 2
Focal Segmental Glomerulosclerosis: State-of-the-Art and Clinical Perspective.Shabaka Amir, Tato Ribera Ana et al.2020Nephron
View 3
Extracorporeal Therapies in the Treatment of Focal Segmental Glomerulosclerosis.Raina Rupesh, Wang Joseph et al.2020Blood purification
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Diagram
FSGS Diagnosis │ ▼ Classification of FSGS Type ┌───────────────────────────────────┐ │ Primary │ Secondary │ Genetic │ └───────────────────────────────────┘ │ ▼ First-Line Treatment (Immunosuppression: Corticosteroids/High-dose Prednisone) │ ▼ Partial/No Remission? │ ├──► Extracorporeal Therapies │ (Plasma Exchange, Immunoadsorption, LDL Apheresis) │ └──► Investigational Agents (Fresolimumab / Anti-TGF-β)
Table
| Treatment | Mechanism | Key Finding |
|---|---|---|
| Extracorporeal Therapies | Removal of circulating permeability factors | Beneficial in drug-resistant and recurrent FSGS |
| Obinutuzumab + Daratumumab | B cell/plasma cell targeting | Enabled plasmapheresis discontinuation and significant proteinuria reduction in rituximab-refractory post-transplant FSGS |
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- Fresolimumab was evaluated only as a single-dose phase I study in 16 patients, limiting conclusions about long-term efficacy; one patient developed a primitive neuroectodermal tumor 2 years post-treatment, raising safety concerns. Trachtman et al. (2011)
- FSGS is a histological pattern with diverse etiologies — primary, secondary, genetic, and virus-associated — each requiring tailored management.
- Extracorporeal therapies such as plasma exchange and immunoadsorption offer benefit in drug-resistant and recurrent FSGS.
- Obinutuzumab combined with daratumumab shows promise as a rescue strategy in post-transplant FSGS refractory to rituximab and plasmapheresis.
- Anti-TGF-β therapy with fresolimumab was well tolerated in a phase I study of treatment-resistant FSGS, warranting further investigation.
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- "Rituximab vs obinutuzumab in nephrotic syndrome randomized trials"
- "Circulating permeability factors in primary FSGS pathogenesis"
- "Genetic FSGS mutations podocin nephrin treatment outcomes"
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