Post-transplant early recurrent proteinuria in patients with focal glomerulosclerosis--angiotensin II immunostaining and treatment outcome.
We reviewed the transplantation data and results of histopathological studies with additional angiotensin II (AII) immunostaining of renal graft biopsies of nine cases (10 grafts) with recurrent proteinuria and three controls without recurrent proteinuria that received renal transplantation for primary focal segmental glomerulosclerosis (FSGS) between 1986 and 2002. Recurrent FSGS was confirmed in six grafts from nine cases by light microscopy. In cases with recurrent proteinuria, loss of graft function was noted in all six renal grafts received between 1986 and early 1992 but in none of four grafts received between late 1992 and 2002. Two of four patients of the late group but none of those of the early group received angiotensin converting enzyme (ACEI) or angiotensin II receptor blocker (ARB) with plasma exchange (PE). In control cases without proteinuria, AII immunostaining was detected in tubules but not in glomeruli in 1-hour biopsies as well as later on. In cases with recurrent proteinuria, AII immunostaining was detected in both tubules and glomeruli, although glomerular AII staining was not observed in 1-hour biopsies. Our results suggest that effective treatment of post-transplantation recurrent FSGS requires ACEI or ARB with PE in the absence of another etiology.
Mizuiri
Sonoo
S
Department of Nephrology, Toho University School of Medicine, Tokyo, Japan. sm210@med.toho-u.ac.jp
Kawamura
Takeshi
T
Miyagi
Moriatsu
M
Arai
Kenji
K
Sakai
Ken
K
Aikawa
Atsushi
A
Ohara
Takehiro
T
Shibuya
Kazutoshi
K
Ishikawa
Yukio
Y
Kawamura
Sadao
S
Hasegawa
Akira
A
D000293:Adolescent; D000328:Adult; D000804:Angiotensin II / Q000378:metabolism*; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005923:Glomerulosclerosis, Focal Segmental / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D010951:Plasma Exchange; D011507:Proteinuria / Q000378:metabolism* / Q000628:therapy*; D011945:Receptors, Angiotensin / Q000627:therapeutic use; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011945:Receptors, Angiotensin; D000804:Angiotensin II