title: [Long-term monitoring of children with focal segmental glomerulosclerosis and a transplanted kidney].
abstract: BACKGROUND
  Focal segmental glomerulosclerosis (FSGS) is an important cause of nephrotic syndrome and end-stage renal disease. Children with FSGS are at a risk of recurrence of disease following renal transplantation. The rate of recurrence has been estimated to range from 15% to 50%, having a potentially detrimental course towards the loss of renal function. The factors associated with an increased probability of recurrence are not well known.
  
  
  METHODS
  The authors followed 8 pediatric patients (3 girls and 5 boys) with FSGS who had undergone renal transplantation (16% of all transplanted pediatric patients) over a long period (1982-2001). The mean age of the children at the time of disease onset was 4 years and 8 months (range: 2 months-12 years). Children were monitored from 10 months to 4 years before the first dialysis. On average, the first dialysis was performed at 7 years of age (range: 12 months-16 years). Time elapsed between the first dialysis and transplantation ranged from 1 to 3 years (mean 1.5 year), and mean age at transplantation was 8 years and 6 months (range: 4-18 years). The grafts were from 2 living-related and 6 cadaveric donors. Five recipients were immunosuppressed with cyclosporin A (CsA) -steroids-azathioprine (Aza), 2 with CsA-steroids-mycophenolate mofetil (MMF), and 1 with CsA-steroids regimen. Follow-up period after transplantation ranged from 2 to 15 years (mean time 7 years and 8 months).
  
  
  RESULTS
  Creatinine values, proteinuria range and blood pressure were monitored every 3 months after transplantation, and were as follows: creatinine 41-386 mumol/l (mean value 153 mumol/l), proteinuria 0.01-3,14 g/l (mean 0.27 g/l, median 0.03 g/l), systolic blood pressure 90-140 mm Hg (mean 110 mm Hg), diastolic blood pressure 60-90 mm Hg (mean 80 mm Hg). Two patients developed hypertension grade I and III after renal transplantation. There were 5 (0.6 per patient) acute rejection episodes. Two grafts (25%) were rejected 5 and 9 years after transplantation, but recurrence of FSGS was not confirmed by renal biopsy.
  
  
  CONCLUSIONS
  Due to the small sample size no firm conclusions about recurrence of FSGS could be made. However, the fact that none of 8 children developed recurrence of FSGS after renal transplantation speaks against the relatively high recurrence rates in our pediatric population.
authors.affiliation: Zavod za dijalizu, Klinicki bolnicki centar Zagreb, Kispatićeva 12, 10000 Zagreb, Hrvatska. djukica@hotmail.com
authors.forename: Durdica
authors.initials: D
authors.lastname: Seso Simić
authors.forename: Jasna
authors.initials: J
authors.lastname: Slavicek
authors.forename: Ljubica
authors.initials: L
authors.lastname: Bubić Filipi
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Puretić
authors.forename: Petar
authors.initials: P
authors.lastname: Kes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D011379:Prognosis; D012008:Recurrence