Purpose of review: We discuss recent work on the pathogenetic mechanism of focal segmental glomerulosclerosis (FSGS) and its relationship to soluble urokinase receptor (suPAR).
Recent findings: Primary FSGS can affect both children and adults. The disease can recur after kidney transplantation suggesting the involvement of a causative circulating factor. Recent work suggests that approximately two-thirds of FSGS patients have elevated levels of serum suPAR, which confers risk to both native and posttransplant FSGS.
Summary: Future studies that are geared to understand the clinical implications of high suPAR levels in native FSGS as well as in the pretransplant and posttransplant setting will allow for better patient risk stratification and more targeted treatment options.