 Primary FSGS thought to be a part of the immune-mediated disease. Main challenge is to decrease protein excretion in urine. Only 30 of children with FSGS achieve complete remission with steroids and other 30-40 patients experience remission partial and complete with cytotoxic immunosuppressant drugs. Even with these treatments, many patients eventually still require dialysis. Other treatment strategy doesnt exceed beyond symptomatic treatment and delaying the progression. Also risk of recurrence after kidney transplantation is 20-50. 