title: Effect of a triple blockade of the renin-angiotensin-system in recurrent focal segmental glomerulosclerosis after kidney transplantation.
abstract: Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation with nephrotic syndrome is a serious problem with a high risk of graft loss. The therapeutic role of renin-angiotensin-system (RAS) blockers in recurrent FSGS is not clear. We present the safety and efficacy of an intensified triple RAS blockade with an ACE-inhibitor, an AT 1 receptor blocker and the direct renin inhibitor aliskiren in a 29-year-old renal transplant recipient with biopsy proven recurrence of FSGS and relapsing severe nephrotic syndrome. We subsequently used full dose ramipril, candesartan and aliskiren under a close monitoring of kidney function and electrolytes and examined the effect on proteinuria, clinical course and tolerability over 12 months. We found a significant and sustained antiproteinuric effect under triple RAS blockade. RAS blockade was generally well tolerated. This can offer a new therapeutic approach in selected hypertensive patients with recurrent FSGS.
authors.affiliation: Department of Nephrology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Freiberger
authors.forename: Kerstin
authors.initials: K
authors.lastname: Amann
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.forename: Helga
authors.initials: H
authors.lastname: Frank
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D001562:Benzimidazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D001713:Biphenyl Compounds; D004359:Drug Therapy, Combination; D005260:Female; D005650:Fumarates / Q000008:administration & dosage / Q000627:therapeutic use*; D005923:Glomerulosclerosis, Focal Segmental / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000209:etiology; D016030:Kidney Transplantation; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology; D010951:Plasma Exchange; D011507:Proteinuria / Q000188:drug therapy / Q000209:etiology; D017257:Ramipril / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000187:drug effects*; D000069283:Rituximab; D013777:Tetrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000092502:Renin Inhibitors
chemical_list: D000577:Amides; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D005650:Fumarates; D017257:Ramipril; D000069283:Rituximab; D013777:Tetrazoles; D000092502:Renin Inhibitors; C446481:aliskiren; C081643:candesartan