Successful Management of Relapsing Primary Focal Segmental Glomerulosclerosis With Tacrolimus and Mycophenolate Multitarget Therapy.

Focal segmental glomerulosclerosis (FSGS) is a leading cause of nephrotic syndrome, often resistant to corticosteroid therapy. We report a 75-year-old female with relapsing primary FSGS successfully treated with a dual regimen of tacrolimus and mycophenolate mofetil (MMF) without steroids or cyclophosphamide. Following three years of combination therapy, with concurrent renin-angiotensin system and sodium-glucose cotransporter-2 inhibition, the patient achieved sustained remission with proteinuria < 500 mg/day, without complications. This case underscores the potential of tacrolimus and MMF as a steroid-sparing strategy in managing refractory FSGS. Further research is needed to validate this approach in larger patient populations.