Focal segmental glomerulosclerosis (FSGS) has become one the leading causes of kidney disease in the United States. With the incidence of FSGS rising over the past decade, capable treatment options have been a large focus in research. One therapy that shows promise is low density lipoprotein apheresis (LDL-A). This procedure removes lipoproteins containing apolipoprotein-B from the blood, thus reducing the lipid load on the renal system. LDL-A also improves responsiveness to the standard FSGS therapy of corticosteroids and cyclosporine. This paper describes the current LDL-A techniques, offers insight to existing clinical studies employing this therapy, and ultimately highlights LDL-A as a treatment option for FSGS, post-renal transplant, and nephrotic syndrome.