Emerging Role of Anti-nephrin Antibodies in Predicting Posttransplant Focal Segmental Glomerulosclerosis Recurrence

Dear Dr Narayan Prasad, I would like to commend the authors of the article “A Comprehensive Look at Focal Segmental Glomerulosclerosis Recurrence in Adult Transplant Patients” for their thorough analysis of recurrent focal segmental glomerulosclerosis (rFSGS) in the Indian population.[1] This study offers valuable insights into the management of rFSGS posttransplant, particularly regarding the use of therapeutic plasma exchange and rituximab. In parallel with these findings, recent studies have highlighted the potential role of anti-nephrin autoantibodies as the predictive biomarkers for rFSGS recurrence. Notably, Batal et al. demonstrated a strong association between the presence of pretransplant anti-nephrin antibodies and increased risk of recurrence.[2] In addition, a multi-institutional study by Shirai et al. further supports this finding, showing that elevated anti-nephrin antibody levels are significantly associated with rFSGS posttransplant.[3] This study reported that plasma levels of anti-nephrin antibodies were markedly higher in patients with posttransplant recurrence and correlated with altered nephrin phosphorylation patterns. These findings suggest that circulating anti-nephrin antibodies may play a crucial role in the pathogenesis of posttransplant rFSGS, potentially mediated by nephrin phosphorylation. While this is a promising development, we understand that anti-nephrin antibody testing is not yet available in India. However, as this test becomes more widely accessible, it could offer an additional tool for identifying high-risk transplant candidates and improving risk stratification. This could help tailor preemptive interventions and enhance the long-term outcomes for transplant recipients. Given the potential of anti-nephrin antibodies in predicting rFSGS recurrence, we look forward to larger studies, including those across diverse ethnic populations, to confirm these findings and help integrate this testing into clinical practice. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.