Listen, folks, we’ve got these two big problems, minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS), okay? They’re tough, they’re tricky, and they’re hurting our kidneys without leaving a trace. Some people say they’re different, some say they’re the same – it’s a debate, believe me. But here’s the thing: we’re hitting them hard with steroids, and when that doesn’t work, we bring in the big guns, the immunosuppressives. But the response? Unpredictable.

We’ve got a situation where we need to know who’s going to benefit from which treatment – it’s crucial, it’s important. And let me tell you, the evidence we have, especially for MCD, it’s not enough. It’s coming from kids, from observations, not the solid trials we want. The 2021 KDIGO guidelines? They’re doing their best, but we need more.

Now, FSGS, that’s another story. You’ve got the primary kind, and then you’ve got the ones that are hiding behind genetics or other conditions. It’s complicated, it’s a challenge for designing trials.

But here’s the good news: the Immunonephrology Working Group (IWG) of the European Renal Association (ERA), they’re on it. They’re looking at the latest and greatest, like rituximab and cyclophosphamide, and they’re not forgetting about supportive treatments. And the clinical trials? They’re happening, they’re ongoing, and they’re going to make a difference. We’re going to figure this out, and we’re going to do it big. That’s what we do, folks.