Abstract: FR-PO0927
Favorable Long-Term Outcome in Steroid- and Cyclosporine-Resistant, Tacrolimus-Responsive FSGS
Session Information
- Glomerular Case Reports: Lupus, FSGS, Complement, and More
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Shankar, Abhirami, Harbor-UCLA Medical Center, Torrance, California, United States
- Dai, Tiane, Harbor-UCLA Medical Center, Torrance, California, United States
- Nast, Cynthia C., Cedars-Sinai, Los Angeles, California, United States
- Adler, Sharon G., Harbor-UCLA Medical Center, Torrance, California, United States
Introduction
Focal Segmental Glomerulosclerosis (FSGS) is a heterogeneous disorder classified as primary, secondary, genetic or unknown underlying cause. Primary FSGS patients often respond to immunosuppression, but many are resistant. Short-term case reports describe occasional cyclosporine (CsA)-resistant, tacrolimus (Tac)-sensitive patients. We report more than a decade of complete remission (CR) with recovered eGFR in a Tac-dependent patient with FSGS.
Case Description
A 52-year-old woman with diabetes and obesity presented with severe nephrotic syndrome, volume overload, and declining renal function, requiring albumin infusions and ultrafiltration. Biopsy revealed FSGS and eosinophilic interstitial nephritis from possible over-the-counter medication. Proteinuria and eGFR did not improve after 4 months of high-dose prednisone or subsequent CsA with low-dose prednisone. A trial of low-dose prednisone with Tac led to complete remission within days (23 g/day to <1 g/day, see Figure 1). Over years, she had multiple transient relapses due to brief Tac non-compliance, each followed by rapid remission upon restarting. MACR remains <30 mcg/mg (see Figure 2) and eGFR is ~55 ml/min/1.73m2. Curated genotyping for 385 kidney-associated genes did not disclose a relevant mutation. Whole exome sequencing is pending.
Discussion
In various studies in children and adults with FSGS, patients with CsA -resistant, dependent or refractory disease, those already in remission on CsA, and a patient with partial-remission on CsA but recurrent FSGS flares requiring repeated rituximab infusions, experienced further improvement in proteinuria, renal function and flare-free sustained remission on transitioning to Tac. However, many patients remained Tac dependent and couldn’t be tapered off the medication. Tac may offer a potentially better alternative to CsA, probably due to distinct mechanisms of action at the podocyte. Genetic testing may help guide further management by identifying podocyte or non-podocyte genetic variants that cause resistance or response to certain therapies.
Response to Treatment(s), Relapse and Remission