Abstract

in their native kidneys and in renal transplants [2, 3]. Preliminary data from the FONT trial (NCT00814255) suggest that some patients treated with oral galactose achieve a significant reduction in proteinuria in parallel with a decline in Palb during 24 weeks of therapy (unpublished observations). In light of these findings, novel biomarkers may be needed to identify patient subgroups who are likely to respond to galactose treatment and a longer period of therapy may be required to fully realize the benefit of therapy. Agents such as rituximab, with response rates of approximately 20 % in pilot studies of steroid-resistant nephrotic syndrome are still under active investigation. Since galactose is non-toxic and since other proven therapeutic options are limited, it may be premature to abandon investigation of galactose and other agents that may inhibit the activity of circulating permeability factors. Additional trials in larger samples of well-characterized patients are warranted and prolonged therapy may show that galactose will reduce proteinuria in at least some patients.

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