title: Update on the treatment of focal segmental glomerulosclerosis in renal transplantation.
abstract: Focal segmental glomerulosclerosis (FSGS) represents one of the most severe glomerular diseases, with frequent progression to end-stage renal disease and a high rate of recurrence in renal allografts (30%-50%). Recurrent FSGS portends a negative outcome, with the hazard ratio of graft failure being two-fold higher then that of other glomerulonephritis. Two patterns of clinical presentations are observed: Early recurrence, which is characterized by massive proteinuria within hours to days after implantation of the renal graft, and late recurrence, which occurs several months or years after the transplantation. Many clinical conditions have been recognized as risk factors for recurrence, including younger age, rapid progression of the disease to end-stage renal disease on native kidneys, and loss of previous renal allografts due to recurrence. However, much less is known about the incidence and risk factors of the so-called "de novo" type of FSGS, for which sufferers are transplanted patients without disease on native kidneys; but, rapid development of allograft failure is frequently observed. Management of both forms is challenging, and none of the approaches proposed to date have been demonstrated as consistently beneficial or effective. In the present review we report an update on the available therapeutic strategies for FSGS in renal transplantation within the context of a critical overview of the current literature.
authors.affiliation: Maria Messina, Ester Gallo, Alberto Mella, Fabiola Pagani, Luigi Biancone, Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, 10126 Turin, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Messina
authors.affiliation: Maria Messina, Ester Gallo, Alberto Mella, Fabiola Pagani, Luigi Biancone, Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, 10126 Turin, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Gallo
authors.affiliation: Maria Messina, Ester Gallo, Alberto Mella, Fabiola Pagani, Luigi Biancone, Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, 10126 Turin, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mella
authors.affiliation: Maria Messina, Ester Gallo, Alberto Mella, Fabiola Pagani, Luigi Biancone, Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, 10126 Turin, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Pagani
authors.affiliation: Maria Messina, Ester Gallo, Alberto Mella, Fabiola Pagani, Luigi Biancone, Renal Transplantation Center "A. Vercellone", Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, Città della Salute e della Scienza Hospital and University of Turin, 10126 Turin, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Biancone
keywords: Focal segmental glomerulosclerosis; Kidney transplantation; Permeability factors; Plasma exchange; Rituximab