AMPK-activation by Metformin in FSGS: AMP-FSGS

Eligibility Criteria

• 1. Provision of signed and dated informed consent form
• 2. Stated willingness to comply with all study procedures and availability for the duration of the study
• 3. Male or female, aged greater than or equal to 18 years, but \</= 80 years age at the time of signing the informed consent
• 4. Biopsy-confirmed primary FSGS as defined by expert renal pathology at either institutions. For homogeneity of diagnoses, demonstrable segmental or global sclerosis lesions (\>/=1 glomerulus) with diffuse podocyte foot process effacement by electron microscopy (\>/+ 50% of examined glomerular tufts).
• 5. Therapeutic plan by treating physician for immunomodulatory treatment using Glucocorticoids.
• 6. Ability to take oral medication and be willing to adhere to the MF or Placebo regimen
• 7. For females of reproductive potential: use of highly effective contraception for at least 1 month prior to screening and agreement to use such a method during study participation and for an additional 12 weeks after the end of VPA administration. For males of reproductive potential: use of condoms or other methods to ensure effective contraception with partner.
• 1. Liver disease: confirmed cirrhosis liver (any stage), acute hepatitis (\> 2 fold increase in liver enzymes, any coagulopathy, hyperbilirubinemia, ascites or encephalopathy)
• 2. estimated GFR \< 32 ml/min
• 3. Diabetes Mellitus diagnosis at the time of biopsy or need for oral hypoglycemic agents/Insulin, or taking Metformin for other indications
• 4. Treatment with another investigational drug or other intervention within 3 months
• 5. Current pregnancy or desire to become pregnant during the study period
• 6. Unwilling to use two forms of birth control (for women of childbearing age)
• 7. Under hospice care
• 8. Confirmed Dementia diagnoses in EMR problem list
• 9. Incarceration
• 10. Homelessness
• 11. Inability to consent
• 12. Currently enrolled in (or completed within the past 30 days) a study of an investigational drug or device.
• 13. Life expectancy of less than 6 months as determined by the clinical judgement of the patient's primary physician
• 14. Allergy or sensitivity to Metformin
• 15. Platelet count \< 100,000/µL; INR \> 1.5; Bleeding diathesis or blood thinner use contraindicating biopsy.
• 16. Simultaneous use of Carbonic anhydrase inhibitor agents
• 17. Use of systemic immunosuppressive medication for non-renal indications.