Dose-Ranging Safety, Tolerability, and Efficacy Study of AZD2373 in Participants With APOL1-Mediated Kidney Disease

The purpose of this study is to assess the efficacy and safety of AZD2373 in participants diagnosed with APOL1-Mediated Kidney Disease (AMKD) who are homozygotes or compound heterozygotes for APOL1 high-risk genotypes (G1 and G2). The primary hypothesis to be evaluated is that AZD2373, compared with placebo, will result in a greater reduction in UACR as assessed by the relative change from Baseline in UACR at Week 30.

Inclusion Criteria: * Age: Male and female participants of African descent (including, but not limited to, Black, Black African, Black Caribbean, African American, Afro-Caribbean, Afro-Latino, West African, Mixed Black backgrounds, or other self-identified African diaspora heritage) aged 18 to 70 years, inclusive at the time of informed consent. * Participants who have high-risk APOL1 genotype (G1/G1; G1/G2; G2/G2). The screening period can be extended if there are delays related to the shipment, handling, or processing of genotype results. * A geometric mean UACR ≥ 300 mg/g calculated based on the mean of readings taken from 3 FMV urine samples collected on 3 consecutive days. Since the mean will be assessed for eligibility, any of the 3 readings may fall below 300 mg/g. * eGFR ≥ 25 mL/min/1.73m2. * Contraceptive use by males or females should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. * Capable of giving signed informed consent which includes compliance with the requirements and restrictions listed in the ICF and in this protocol. Exclusion Criteria: * Participants with diagnosis of Type 1 diabetes mellitus. * Body Mass Index \> 45 kg/m2. * SBP \> 180 mmHg/DBP \> 110 mmHg (measured when the participant is considered to be at steady state, and preferably when they have taken their BP medications that same day). * QTcF \> 470 ms, except participants with bundle branch block who should excluded if QTcF\> 480 ms. * Acute coronary syndrome/Acute myocardial infraction with or without any coronary intervention within 6 months. * Transient ischaemic attack/ stroke within 3 months. * High grade (second to third) degree AV block or clinically significant sinus node dysfunction untreated with pacemaker. * A history of ventricular arrhythmias requiring treatment. * Participants with Type 2 diabetes mellitus must be excluded if ANY of the following conditions are present: 1. Current or past use of insulin for more than 3 months and/or any maintenance therapy with insulin within 2 months of screening. 2. Screening Haemoglobin A1c \> 8.0% 3. Receiving more than one anti-hyperglycaemic agent (excluding SGLT inhibitors and GLP-1 receptor agonists is permitted if prescribed for a purpose other than glycaemic control which can be taken in addition to one other anti-hyperglycaemic agent). * Participant on kidney replacement therapy (dialysis or kidney transplant) or any other organ transplant. * History or serologic evidence of autoimmune-mediated glomerular disease including but not limited to: lupus nephritis (positive lupus serology), ANCA associated vasculitis (antineutrophil cytoplasmic antibody), membranous nephropathy (anti-phospholipase A2 receptor antibody or other autoantibody associated with membranous nephropathy), anti-GBM disease (anti-GBM antibody), or IgA nephropathy. * Another underlying cause of kidney disease that is not associated with APOL1, including but not limited to polycystic kidney disease or, congenital anomalies of the kidney and urinary tract. * History of a diagnosed coagulopathy, a major unexplained bleeding event, or other high-risk bleeding diathesis. * A history of trypanosomiasis or leishmaniasis.