Advances in the pathophysiology and treatment of focal segmental glomerulosclerosis: The importance of a timely and tailored approach

Abstract

Focal segmental glomerulosclerosis (FSGS) is a histological pattern of glomerular damage that significantly contributes to chronic kidney disease and end-stage renal disease. Its incidence is rising globally, necessitating timely and personalized management strategies. This paper aims to provide an updated overview of the pathophysiology, diagnosis, and therapeutic strategies for FSGS, emphasizing the importance of early interventions and tailored treatments. This editorial synthesizes key findings from recent literature to highlight advancements in understanding and managing FSGS. Emerging evidence supports the role of targeted therapies and personalized approaches in improving outcomes for FSGS patients. Advances include novel biomarkers, genetic testing, and innovative therapeutics such as transient receptor potential ion channel blockers and antisense oligonucleotides for apolipoprotein 1-related FSGS. Effective management of FSGS requires a combination of timely diagnosis, evidence-based therapeutic strategies, and ongoing research to optimize patient outcomes and address gaps in the current understanding of the disease.

Keywords: Focal segmental glomerulosclerosis; Chronic kidney disease; Glomerulonephritis; Renal failure; Immunosuppressive therapy; Calcineurin inhibitors; Mycophenolate mofetil; Rituximab; Sparsentan; Plasmapheresis

Core Tip: Focal and segmental glomerulosclerosis is currently considered a histologic pattern encompassing several clinicopathologic entities. Its incidence is increasing worldwide. The rising prevalence is likely due to improved diagnosis and recognition of the disease, combined with a better understanding of the pathophysiology of podocyte damage and the development of therapeutics targeting the mediators underlying this clinicopathologic condition.