Research on the Pathogenesis of Post-Transplant Recurrent Focal Segmental Glomerulosclerosis Associated with Anti-Nephrin Autoantibodies

Abstract

The cause of primary nephrotic syndrome remained elusive for many years. In 2022, a significant breakthrough was achieved when anti-nephrin autoantibodies were identified as being involved in the pathogenesis of minimal change disease. On the other hand, focal segmental glomerulosclerosis (FSGS) is a rare and steroid-resistant nephrotic syndrome with a high recurrence rate following kidney transplantation. We conducted a multi-institutional study and demonstrated that anti-nephrin autoantibodies are also detected in post-transplant recurrent FSGS, supporting the notion that they may function as one of the circulating factors. Furthermore, we have initiated analyses on the nephrin epitopes recognized by autoantibodies obtained from patients with post-transplant recurrent FSGS. We aim to deepen the understanding of the immunopathogenesis of the post-transplant recurrent FSGS and to identify targets for diagnosis and therapy. In this review, we summarize the latest findings from our ongoing research on the role of anti-nephrin autoantibodies in post-transplant recurrent FSGS.