Travere and KDIGO Podcast Collaboration

Conversations in Nephrology: Proteinuria First: Managing What Matters in FSGS

Episode Summary

In this Travere-sponsored episode of KDIGO Conversations in Nephrology, Dr. Kirk Campbell is joined by Dr. Laura Mariani for an in-depth discussion on the central role of proteinuria reduction in the management of focal segmental glomerulosclerosis (FSGS).

Together, they discuss the biological and clinical importance of proteinuria in FSGS, including the biologic link between podocyte injury and proteinuria, and its utility for guiding patient management and clinical trial design.

Dr. Laura Mariani, one of the leads of the PARASOL project, reflected on the initiative’s origins, collaborative approach, and key findings.

PARASOL, an international effort to define acceptable, data-driven endpoints for FSGS clinical trials, reinforced proteinuria reduction as a strong predictor of long-term kidney outcomes, underscoring its importance as a treatment target.

Dr. Laura Mariani, MD – University of Michigan

Dr. Kirk Campbell, MD (host) – University of Pennsylvania

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Key Takeaways

“FSGS is really a pattern of injury, and we know that it results from multiple underlying biological processes. But I think whether that is a circulating factor or a genetic variant or any of the other many secondary causes of FSGS, like viruses or toxins, fundamentally FSGS really is a disease of unhealthy podocytes. And when you have those unhealthy podocytes and you lose them, the biomarker we observe is proteinuria.” (1:03)

“We know there’s so many things that can affect GFR and make it fluctuate, make it hard to interpret, whereas proteinuria, the link between proteinuria and risk of kidney failure in FSGS is just much tighter.” (9:27)

“Proteinuria is one of the key things that we were looking at before PARASOL, but I think even more so afterwards made me feel more confident that proteinuria is something we should try to reduce in our patients with this disease.” (11:21)

FSGS is a pattern of glomerular injury with multiple underlying biological processes
Regardless of etiology, FSGS is characterized by a histologic pattern of injury, often manifesting with proteinuria resulting from podocyte injury or dysfunction
In patients with FSGS, higher levels of proteinuria are associated with increased risk of disease progression and kidney failure
The PARASOL initiative evaluated whether short-term changes in proteinuria and estimated glomerular filtration rate (eGFR) could predict long-term kidney failure risk
PARASOL demonstrated a strong association between achieving lower proteinuria thresholds and reduced risk of kidney failure, reinforcing that reduction in proteinuria is critical for long-term kidney outcomes in FSGS

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Disclaimer: This episode of Conversations in Nephrology was supported by Travere Therapeutics and developed by Kidney Disease: Improving Global Outcomes. The opinions presented are those of the individual speakers and not those of Travere Therapeutics. This podcast episode was published on May 27, 2026. Please always consult updated sources for the latest information, as information discussed may have changed since the recording date.

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