Double recurrence of FSGS after two renal transplants with complete regression after plasmapheresis and ACE inhibitors.
A patient who had undergone a first cadaveric donor kidney transplantation for idiopathic focal segmental glomerular sclerosis (FSGS), had an immediate recurrence of a biopsy-proven FSGS that eventually led to graft failure within 5 years from transplantation. The patient underwent a second cadaveric transplantation 10 months later. An immediate recurrence of a biopsy-proven FSGS occurred that was treated with two protracted cycles of plasmapheresis of seven months each, with the addition of an ACE inhibitor from the beginning. A complete and stable remission of FSGS was observed, which continues after more than 6 years from the end of plasmapheresis. The recurrence of FSGS after a second transplantation has a poor prognosis, but prolonged plasmapheresis treatment, by removing circulating factors altering glomerular permselectivity, and the addition of ACE inhibitors, through their potential interference with TGF-beta, might be synergistic in obtaining permanent remission.
Montagnino
G
G
Divisione di Nefrologia e Dialisi, Ospedale Maggiore IRCCS, Milan, Italy. monta@polic.cilea.it
Tarantino
A
A
Banfi
G
G
Maccario
M
M
Costamagna
L
L
Ponticelli
C
C
D000328:Adult; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D010956:Plasmapheresis; D012008:Recurrence; D014184:Transplantation, Homologous
D000806:Angiotensin-Converting Enzyme Inhibitors