 Patients with resistant FSGS have persistent proteinuria and a high risk of progression to end stage kidney disease ESKD. A circulating factor that increases glomerular permeability to albumin Palb has been detected in over 50 of these patients. While the molecular identity of the factor has not been fully established, in vitro studies and limited clinical experience suggest that galactose can reduce the level of the FSGS permeability factor. 