The role of matrix metalloproteinase inhibitor (doxycycline) in the treatment of primary focal segmental glomerulosclerosis

Abstract

Background Focal and segmental glomerulosclerosis (FSGS) is a histological pattern used in clinical practice to define a podocytopathy that develops with nephrotic-range proteinuria and segmental obliteration or collapse of glomerular capillary loops with increased extracellular matrix in some glomeruli. The major concerns of idiopathic FSGS are the poor renal prognosis with an absence of response to immunosuppressive therapies or relapses and its recurrence after kidney transplantation in ⁓30–50% of patients, which leads to renal graft failure. The aim of this work is to study the possible role of matrix metalloproteinase inhibitor (doxycycline) in the treatment of primary FSGS. Patients and methods This prospective cohort study was conducted on 100 patients with FSGS. Patients were randomly divided into two equal groups: group 1: patients with FSGS under conventional therapy as a control group. Group 2: patients with FSGS under conventional therapy and doxycycline 100 mg/day for 3 months. Patients were closely monitored for treatment effects and adverse reactions. Clinical, laboratory, and radiological parameters were assessed. Treatment outcomes, including remission of proteinuria and adverse effects, were evaluated. Results Group 2 showed significantly lower levels of triglycerides and fasting blood glucose compared with group 1. Doxycycline-related side effects were observed in some group 2 patients. Both groups showed increased hemoglobin levels and decreased C-reactive protein levels at follow-up. Kidney function tests improved in both groups, with group 2 demonstrating superior outcomes. Group 2 showed higher rates of improvement and lower incidence of end-stage renal disease requiring hemodialysis. Conclusion Adding doxycycline to conventional therapy holds promise for treating primary FSGS. Patients receiving combined therapy exhibited enhanced renal function, reduced proteinuria, and better treatment outcomes.