Treatment of Focal Segmental Glomerulosclerosis in Low- and Middle-Income Countries: Emerging Extracorporeal Therapies

Focal segmental glomerulosclerosis (FSGS) involves glomerular scarring and podocyte injury. FSGS treatment typically involves the use of corticosteroids and immunosuppressants. In patients with steroid-resistant FSGS, however, no ideal treatment exists. Extracorporeal therapies such as plasma exchange and low-density lipoprotein apheresis (LDL-A) may be promising options for managing lipid-mediated nephrotoxicity found in patients with steroid-resistant FSGS. Unfortunately, these extracorporeal techniques are inaccessible in many low- and middle-income countries (LMICs) due to high costs and infrastructure challenges. The use of extracorporeal therapies for FSGS management was evaluated at a single center. Additionally, a literature search was conducted across multiple databases to identify studies that explored FSGS treatment modalities in LMICs. Eligibility was assessed based on discussion of viability, efficacy, and application of therapies. At a single center, we found that double filtration plasmapheresis (DFPP) with the Evaflux filter was the most frequently used and most effective method of extracorporeal therapy for FSGS in terms of remission. The development of improvements in extracorporeal therapy, such as modified double filtration plasmapheresis (DFPP), may offer cost improvements due to reduced fluid replacement, which may lead to increased use in LMICs. Twinning programs and governmental intervention may be used to address the gaps in FSGS care in LMICs. Future efforts involve expanding access to plasmapheresis in the management of FSGS, especially in resource-limited settings.