This is not unexpected, as children with FSGS often undergo pretransplant bilateral nephrectomies to normalize serum albumin levels, reduce the thrombotic risk associated with nephrotic syndrome, and improve the ability to diagnose posttransplant FSGS recurrence by eliminating proteinuria from native kidneys.22,23 Pretransplant native nephrectomies necessitate dialysis initiation, precluding preemptive kidney transplantation. Here, ALB is linked to focal segmental glomerulosclerosis.