TITLE:
Combined Therapy of Cyclosporine A, Mycophenolate, Losartan, and Finerenone in Drug-Resistant NOS-Focal Segmental Glomerulosclerosis
AUTHORS:
Kamel El-Reshaid, Shaikha Al-Bader, Ahmad Altaleb
KEYWORDS:
Calcineurin Inhibitors, Corticosteroid Resistant, Cyclosporine A, Focal Segmental Glomerulosclerosis, Mycophenolate Mofetil, Nephrotic Syndrome
JOURNAL NAME:
Open Journal of Nephrology,
Vol.16 No.2,
June
18,
2026
ABSTRACT: Background: Focal and segmental glomerulosclerosis (FSGS) is a common and progressive podopathic glomerulopathy that is resistant to treatment with corticosteroids (70%) and calcineurin-inhibitors (50%). Hence, its primary phenotype is associated with kidney loss in 50% of those with persistent nephrotic syndrome (NS) within 3 - 8 years of diagnosis. The Case: A 26-year-old woman presented with severe NS, hypertension, and hematuria. Investigations excluded genetic mutations, chronic drug use, kidney maladaptations, autoimmune disorders, chronic infections, and toxin exposure. Her kidney biopsy showed focal and segmental glomerular sclerosis with synechial adhesion without cellular proliferation and necrosis, or basement membrane thickening and collapse. On electron microscopy, it showed diffuse effacement of podocyte foot processes. Hence, she had non-otherwise specific FSGS. Her hypertension was controlled with losartan, yet her severe NS (proteinuria > 9 g/day and hypoalbuminemia