ACTN4 and stage 5 chronic kidney disease: Furthermore, in contrast to the typically diffuse podocyte foot process effacement observed in kidney biopsies from individuals with these recessive forms of disease, individuals with ACTN4-associated FSGS have focal podocyte abnormalities, nonnephrotic levels of proteinuria, and slowly progressive adult-onset disease leading to significant (and often end-stage) renal failure in adulthood.