From podocyte pathophysiology to personalized therapy

Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in childhood. For a long time, it was considered a clinically defined, non-specific entity whose treatment was primarily based on glucocorticoid sensitivity. However, new findings paint a more precise picture: Idiopathic nephrotic syndrome – especially the steroid-sensitive form – is to be understood in essential parts as an autoimmune-driven disease in which B-cell dysregulation, autoantibodies against podocytic antigens and genetic predispositions interact. This opens up a new paradigm in pathogenesis, diagnostics and therapy, paving the way for individualized approaches.