Work

Finerenone Use in Coenzyme Q8B–Related Focal Segmental Glomerulosclerosis

Year: 2026

Type: article

Abstract: Introduction Genetic focal segmental glomerulosclerosis (FSGS) caused by a mutation in the coenzyme Q (COQ) is a rare podocytopathy that is associated with poor response to immunosuppression. Finerenone is a non-steroidal mineralocorticoid antagonist that reduces oxidative stress, glomerular inflammation and fibrosis, features seen in COQ coenzyme deficiency. We report the first case of its use in COQ8B–related FSGS. Case Presentation A 35-year-old woman was evaluated for persistent post-partum proteinuria and underwent a kidney biopsy that showed features of focal segmental glomerulosclerosis. She has a strong family history of early-onset kidney failure. She had no response to corticosteroids, Tacrolimus and Empgagliflozin. Genetic testing revealed homozygous COQ8B mutation. CoQ10 supplement was not tolerated. Finerenone was initiated in May 2024 with significant improvement in albuminuria from 6,460 mg/g to 1,430 mg/g after 12 months and a slowing of eGFR decline rate from −9.55 ml/min/1.73m2/year to −6.77 ml/min/1.73m2/year. There was only mild transient hyperkalaemia. It was stopped after 12 months due to hypotension, and by six months the proteinuria increased to 4,860 mg/g and creatinine from 1.56 mg/dL to 2.22 mg/dL. Conclusion This case suggests a potential role for finerenone as adjunctive therapy in genetic FSGS.

Source: Kidney Medicine

DOI: 10.1016/j.xkme.2026.101502

Authors: Manaf Aljishi, Mohamed Khogali, Turki Alhussain, Tofol Alnashmi

Institutions: King Faisal Specialist Hospital & Research Centre, King Fahad Specialist Hospital

Language: English

Topic: Renal Diseases and Glomerulopathies

Subfield: Nephrology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,590