ACTH Treatment of APOL1- Associated Nephropathy

Inclusion Criteria: * Non-diabetic African-American with two APOL1-risk genotypes * Age ≥21 years * BMI \< 40 kg/m2 * Hemoglobin A1c \<6.5% * eGFR ≥30 ml/min/1.73m2 * Historical urine protein: creatinine ratio ≥ 1.0 g/g * Strong clinical suspicion of APOL1-associated nephropathy or history of biopsy proven focal segmental glomerulosclerosis (FSGS) or focal global glomerulosclerosis (FGGS) * Women of childbearing potential: negative serum pregnancy test at Screening and agreement to follow a medically acceptable form of contraception for the duration of Acthar administration and 4 weeks thereafter Exclusion Criteria: * Diagnosis of diabetes mellitus and/or on pharmacologic treatment for diabetes * Medical condition that could cause secondary FSGS * History of sensitivity to steroids (psychosis, steroid-induced diabetes) * Chronic systemic corticosteroid use (Prednisone or equivalent systemic steroid taken for more than 4 consecutive weeks within 6 months prior to screening). Intra-articular, inhaled, and topical steroids are not exclusion criteria. * Contraindication to Acthar per package insert: scleroderma, osteoporosis, systemic fungal infections, ocular herpes simplex, recent surgery (within previous 6 months), history of or the presence of peptic ulcer (within 6 months prior to Screening), adrenal insufficiency or hyperfunction. * Acute glaucoma diagnosed ≤3 months prior to Screening * Biopsy proven glomerular disease other than FSGS or FGGS * Live or live attenuated vaccine received within 1 month prior to screening, or planned administration once enrolled in the study * Uncontrolled hypertension (HTN) (≥ 180/110 mmHg) and frequent admissions (≥1 admission per 6 months interval) for hypertensive urgency or hypertensive emergency * Unstable cardiovascular disease: history of congestive heart failure (NYHA Functional Class III-IV); history of dilated cardiomyopathy with ejection fraction \< 40%; any of the following events within 3 months of screening: unstable angina, myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, transient ischemic attack or cerebrovascular accident, unstable arrhythmia * Uncontrolled volume overload: history of moderate or severe peripheral edema; on loop diuretics ≥ 120 mg daily of furosemide or ≥ 3.0 mg daily of bumetanide or ≥ 150 mg daily of ethacrynic acid or ≥ 60 mg daily of torsemide; * History of secondary hypertension (i.e., renal artery stenosis, primary aldosteronism or pheochromocytoma) * Significant comorbidities (e.g., advanced malignancy, advanced liver disease) with a life expectancy of less than 1 year * Subject is expected to initiate dialysis within 6 months * Previous treatment on a drug being investigated for the treatment of FSGS * Known diagnosis of Human Immunodeficiency Virus, Hepatitis B, or Hepatitis C * Known history of a primary immunodeficiency or an underlying condition such as splenectomy that predisposes the subject to infections * Systemic hematologic disease (e.g., hematologic malignancy, sickle cell anemia, myelodysplastic syndrome) * Current malignancy or history of malignancy within 5 years of screening, with the exception of non-melanoma skin cancers and cervical intraepithelial neoplasia * Treatment for any malignancy (e.g., radiation, chemotherapy, hormone therapy, or biologics) within 5 years of screening, with the exception of locally excised non-melanoma skin cancer or cervical intraepithelial neoplasia * Pregnant or breast feeding, or might become pregnant during the study or within 4 weeks after the end of treatment * Female of reproductive potential not willing to use highly effective methods of birth control during treatment and for 4 weeks after the end of treatment * Currently receiving systemic antibiotics for treatment of an active infection; or history of frequent infections (more than one event per 6 months) * History of any organ transplant * Bipolar disorder, or Major Depressive Disorder characterized by severe depression requiring hospitalization, or history of suicidal ideation/attempts * Currently enrolled in another interventional study, or less than 4 weeks since ending another interventional study(s) or receiving investigational agents(s) * Subject has a disorder that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent and/or comply with all required study procedures.