Symptoms, Causes, Diagnosis & Treatment

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Treatment and Medication Options for FSGS

FSGS is treatable, but not curable, since scarred glomeruli cannot be repaired. The current FSGS treatments work by helping to control symptoms and protect glomeruli, which can slow disease progression and achieve remission.

Medication Options for FSGS

Currently, the only medication approved to treat FSGS (all types) without nephrotic syndrome is sparsentan (Filspari), which was approved by the U.S. Food and Drug Administration (FDA) in April 2026. The medication works by reducing proteinuria, or excess protein in the urine.

Immunosuppressants

For primary FSGS, high-dose corticosteroids like prednisone are used to reduce proteinuria. Some people achieve partial or full remission from this treatment alone.

If steroids are not fully effective or the side effects are too severe, your doctor may recommend another type of immunosuppressant drug called calcineurin inhibitors (CNIs), which includes cyclosporine (Gengraf, Neoral, Sandimmune) and tacrolimus (Astagraf XL, Envarsus XR). These drugs require close monitoring.

If you’re unable to use steroids or CNIs, alternative immunosuppressant drugs include:

Medications for Symptom Management

Various other drugs are used to help manage specific symptoms of FSGS, regardless of which type you have. These include:

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin 2 receptor blockers (ARBs) to reduce blood pressure and proteinuria (these drugs should not be used with sparsentan)
  • Diuretics to remove excess salt and water from the body, decreasing swelling and blood pressure
  • Antibiotics like penicillin to prevent or treat infections

  • Statins or other medications to lower cholesterol

Other Treatment Options

If FSGS progresses, you may require treatments such as a kidney transplant. Sometimes, FSGS comes back after a kidney transplant, which is known as recurrence. If this occurs, you may receive plasmapheresis or other medications.

Kidney Transplant

A kidney transplant is a procedure that places a healthy kidney from a living or deceased donor into a person whose kidneys are no longer working effectively (for example, in someone who has kidney failure).

Research suggests up to 32 percent of people with primary FSGS experience post-transplant recurrence. And people with some types of genetic FSGS also have a high risk of post-transplant recurrence — up to 34 percent for those with an NPHS1 gene mutation, for example.

Plasmapheresis

Plasmapheresis, also known as plasma exchange, is a treatment option if you have recurrent FSGS. This procedure involves drawing out your blood, removing the fluid part of it (the plasma), replacing the plasma with donor plasma, and returning the treated blood to your body. This treatment may help decrease proteinuria and improve your response to other FSGS treatments.



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