Kidney Week

Abstract: SA-PO864

Successful Management of Relapsing Primary FSGS with Tacrolimus and Mycophenolate Multitarget Therapy

Session Information

• Glomerular Diseases: Case Reports - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Lee, Frank, University of California Irvine School of Medicine, Irvine, California, United States

Frank Lee

• Quizon, Marrey Ruby L., Division of Nephrology, Department of Medicine, University of California-Irvine, Irvine, California, United States

Marrey Ruby L. Quizon, MD

• Lau, Wei Ling, Division of Nephrology, Department of Medicine, University of California-Irvine, Irvine, California, United States

Wei Ling Lau, MD, FASN

Introduction

Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome in adults. Multitarget immunosuppressive therapy has shown promise in lupus nephritis, but there is limited evidence in primary FSGS. Here, we describe a case of relapsing FSGS treated using a combination of tacrolimus and mycophenolate with years of stable disease remission.

Case Description

A 75-year-old female presented with recurrent nephrotic syndrome flares over several years. She had 2 native kidney biopsies (done 3 years apart) that showed FSGS (NOS variant with diffuse podocyte foot process effacement, 30% glomeruli with segmental sclerosis, 35% interstitial fibrosis). Other medical history is significant for CKD stage 3b, hypertension, type 2 diabetes mellitus and dyslipidemia. At time of initial diagnosis, the patient had 8.5 g/day of proteinuria and was treated with cyclosporine, on which she achieved partial remission with decrease in proteinuria to 3.5 g/day. The patient declined steroid therapy due to concerns about potential side effects. After 2 years on cyclosporine, she had proteinuria flare 7 g/day and therapy was changed to rituximab (375 mg/m² weekly x4 doses). She had good response with decrease in proteinuria <1 g/day, but had annual FSGS flare with nephrotic syndrome requiring repeat rituximab dosing (3 courses over 3 years). In early 2021, the patient was started on multitarget therapy with low-dose tacrolimus and mycophenolate mofetil. SGLT2 inhibitor therapy was added in early 2023. Patient is doing well after 3 years on this combination therapy, with stable proteinuria around 500 mg/day.

Discussion

This case demonstrates the feasibility of using tacrolimus and mycophenolate multitarget therapy to achieve successful long-term management of primary FSGS.