title: Focal segmental glomerular sclerosis recurrence with massive proteinuria and anuria immediately after kidney transplantation.
abstract: Here, we report a case of focal segmental glomerular sclerosis (FSGS) recurrence immediately (47 minutes) after transplantation. A 1-hour biopsy specimen showed large periodic acid-Schiff-positive granules within the cells of the swollen proximal tubule, while electron microscopy revealed podocyte swelling and partial foot process effacement. These findings were worse on day 2 biopsy. Massive proteinuria and anuria were then observed. Two courses (2 × 2 times) of plasmapheresis and rituximab were administered, and the graft function gradually recovered. A day 22 biopsy specimen showed improvement in findings compared to those observed on day 2. One year after transplantation, no signs of FSGS recurrence are evident, and graft function remains good.
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Maruyama
authors.affiliation: Clinical Research Center, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kitamura
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Naotake
authors.initials: N
authors.lastname: Akutsu
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Otsuki
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Aoyama
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Ikuko
authors.initials: I
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Saigo
authors.affiliation: Department of Surgery, Chiba-East National Hospital, Chiba city, Japan.
authors.forename: Takehide
authors.initials: T
authors.lastname: Asano
mesh_terms: D001002:Anuria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D001706:Biopsy; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology / Q000648:ultrastructure; D016030:Kidney Transplantation / Q000009:adverse effects*; D007687:Kidney Tubules, Proximal / Q000473:pathology; D008854:Microscopy, Electron; D008875:Middle Aged; D010956:Plasmapheresis; D050199:Podocytes / Q000648:ultrastructure; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D020127:Recovery of Function; D012008:Recurrence; D000069283:Rituximab / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: Focal segmental glomerular sclerosis; Plasmapheresis; Post-transplant recurrence; Rituximab