Travere and KDIGO Podcast Collaboration

Conversations in Nephrology: Treating FSGS: From Steroids to Dual Endothelin Angiotensin Receptor Antagonists and What Comes Next

Episode Summary

In this Travere-sponsored episode of KDIGO Conversations in Nephrology, Dr. Kirk Campbell is joined by Dr. Jai Radhakrishnan for an in-depth discussion on navigating the shifting landscape of focal segmental glomerulosclerosis (FSGS) management.

The conversation dives deep into the diagnostic complexities of FSGS, moving beyond histological patterns to understand the diverse drivers of podocyte injury. Dr. Radhakrishnan shares his practical clinical algorithm; based on his experience, he offers a roadmap for balancing supportive care, immunosuppression, and the integration of novel, non-immunosuppressive therapies.

The episode explores how treatment decisions may be potentially driven by biomarkers and a biology-driven management strategy, rather than defaulting to immunosuppressive therapy.

Dr. Jai Radhakrishnan, MD – Columbia University

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

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Key Takeaways

“Sparsentan is a single molecule and that blocks two pathways concurrently, the endothelin A receptor as well as the angiotensin II type 1 receptor. So conceptually it is dual endothelin and angiotensin blockade that is aimed at reducing proteinuria.” (4:15)

“FSGS trials are hard, the biology is mixed, there is variable chronicity of enrollment, and the relatively short windows to detect differences in kidney function decline may not leave room for change in the eGFR slope. Proteinuria reduction remains clinically useful.” (5:52)

“The treatment paradigm in FSGS is now moving from broad empiric approaches with non-specific agents like corticosteroids, toward a more precise biology driven strategy that pairs off to supportive care with targeted therapies and biomarker-informed immunomodulation.” (10:49)

Supportive care is vital in FSGS management as it helps manage edema and blood pressure
FSGS falls within cardiovascular kidney metabolic (CKM) syndrome, making cardiovascular risk reduction important
FSGS is a heterogeneous condition with varying prognoses. Patients may experience relapse, steroid dependence, or toxicities with historic treatments
When treating FSGS etiologies that are not primary in nature, supportive care should be emphasized and referral to a center with expertise in glomerular disease should be considered. Additionally, therapies that target podocyte injury without assuming an immune-mediated mechanism may be appropriate compared to immunosuppression
Sparsentan, a single-molecule, non-immunosuppressive Dual Endothelin Angiotensin Receptor Antagonist (DEARA), has demonstrated proteinuria reduction and a comparable safety profile vs. maximum-labeled dose irbesartan in the Phase 2 DUET and Phase 3 DUPLEX trials
The treatment landscape for FSGS is evolving with a focus on targeted therapies. A precise, biology-driven strategy will support individualized care

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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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