title: Protocol biopsies for focal segmental glomerulosclerosis treated with plasma exchange and rituximab in a renal transplant patient.
abstract: We discuss a renal transplant patient with focal segmental glomerulosclerosis (FSGS) treated with plasma exchange and rituximab. A 45-yr-old woman underwent cadaveric renal transplantation in May 2008. She had started hemodialysis support in 1991. Immediately after transplantation, massive proteinuria (1-5 g/d) appeared. Graft biopsy at one h showed minor glomerular abnormalities with partial foot process effacement on electric microscopy. Protocol biopsy at three months after transplantation for persistent proteinuria showed obvious FSGS under light microscopy. Plasma exchange and rituximab administration were subsequently initiated in August 2008, and proteinuria disappeared within a month after starting these treatments. Protocol graft biopsy one yr after transplantation (2009) showed increased global sclerosis and a decrease in segmental sclerosis. In addition, foot process effacement had recovered by one yr after transplantation. Plasma exchange and subsequent rituximab administration led to clinical remission of post-transplant FSGS with improvement in podocyte structure. Rituximab should be considered soon after several sessions of plasmapheresis in transplant patients with recurrent FSGS.
authors.affiliation: Department of Nephrology, Toho University School of Medicine, Tokyo, Japan. kensakai@med.toho-u.ac.jp
authors.forename: Ken
authors.initials: K
authors.lastname: Sakai
authors.forename: Jirou
authors.initials: J
authors.lastname: Takasu
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nihei
authors.forename: Takashi
authors.initials: T
authors.lastname: Yonekura
authors.forename: Yujirou
authors.initials: Y
authors.lastname: Aoki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Sonoo
authors.initials: S
authors.lastname: Mizuiri
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aikawa
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D003131:Combined Modality Therapy; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008875:Middle Aged; D010951:Plasma Exchange; D011507:Proteinuria / Q000188:drug therapy; D006435:Renal Dialysis; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab