title: Complete Remission of Post-transplantation Recurrence of Focal Segmental Glomerulosclerosis With the Use of Adrenocorticotrophic Hormone Gel: Case Report.
abstract: BACKGROUND
  Post-transplantation recurrence of primary focal and segmental glomerulosclerosis (FSGS) is estimated to occur in 30%-50% of cases and doubles the risk of allograft failure. Treatment of recurrent FSGS is challenging because specific pathogenic targets are unknown and available therapeutic options have limited efficacy.
  
  
  METHODS
  We report a case of recurrent FSGS with nephrotic-range proteinuria (urine protein creatinine ratio [UPCR], >50) and debilitating edema that was resistant to rituximab and plasmapheresis. The patient had a remarkable response to adrenocorticotropic hormone (ACTH) gel and achieved complete remission (UPCR, 0.5; serum albumin, 4.1 g/dL; serum creatinine, 1.0 mg/dL) which was maintained over 10 months on this treatment.
  
  
  CONCLUSIONS
  We conclude that ACTH gel is a potential therapeutic option for post-transplantation recurrence of FSGS and warrants further evaluation.
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: T
authors.initials: T
authors.lastname: Mittal
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: P
authors.initials: P
authors.lastname: Dedhia
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: P
authors.initials: P
authors.lastname: Roy-Chaudhury
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: B G
authors.initials: BG
authors.lastname: Abu Jawdeh
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: G
authors.initials: G
authors.lastname: Mogilishetty
authors.affiliation: Division of Transplant Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: M C
authors.initials: MC
authors.lastname: Cuffy
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio.
authors.forename: R R
authors.initials: RR
authors.lastname: Alloway
authors.affiliation: Division of Transplant Surgery, University of Cincinnati, Cincinnati, Ohio.
authors.forename: E S
authors.initials: ES
authors.lastname: Woodle
authors.affiliation: Division of Nephrology, University of Cincinnati, Cincinnati, Ohio. Electronic address: amit.govil@uc.edu.
authors.forename: A
authors.initials: A
authors.lastname: Govil
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000008:administration & dosage*; D000369:Aged, 80 and over; D001706:Biopsy; D004487:Edema / Q000188:drug therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D009404:Nephrotic Syndrome; D010956:Plasmapheresis / Q000379:methods*; D011183:Postoperative Complications; D011184:Postoperative Period; D011507:Proteinuria / Q000188:drug therapy; D012008:Recurrence; D012074:Remission Induction; D051437:Renal Insufficiency / Q000628:therapy; D000069283:Rituximab / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab; D000324:Adrenocorticotropic Hormone