Recurrent focal segmental glomerulosclerosis apparently resistant to plasmapheresis improves after surgical repair of arteriovenous fistula aneurysms.
Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage renal disease and has a high recurrence rate after kidney transplantation, attributed to a circulating permeability factor. Plasmapheresis is the treatment of choice after recurrence to remove the circulating factor. We present a case of recurrent FSGS 6 years after transplantation. It is instructive because proteinuria did not respond to intensive plasmapheresis-combined with rituximab-until the possibility of ineffective apheresis secondary to multiple aneurysms in the arteriovenous fistula (AVF) was considered. Proteinuria improved soon after alternative access for plasmapheresis was secured and AVF aneurysms were surgically repaired.
Department of Pathology and Laboratory Medicine , Boston Medical Center , Boston, MA 02118 , USA.
Yanli
Y
Ding
Department of Medicine , Boston Medical Center , Boston, MA , USA.
Jean
J
Francis
Department of Surgery , Boston Medical Center , Boston, MA , USA.
Jeffrey
J
Kalish
Department of Pathology and Laboratory Medicine , Boston Medical Center , Boston, MA 02118 , USA.
Anita
A
Deshpande
Department of Pathology and Laboratory Medicine , Boston Medical Center , Boston, MA 02118 , USA.
Karen
K
Quillen
FSGS; arteriovenous fistula; kidney transplantation; plasmapheresis; vascular access