Double recurrence of FSGS after two renal transplants with complete regression after plasmapheresis and ACE inhibitors

Montagnino, Giuseppe; Tarantino, A; Banfi, Giovanni; Maccario, Massimo; Costamagna, Laura; Ponticelli, Claudio

doi:10.1111/j.1432-2277.2000.tb01059.x

Cited by 14 publications

(2 citation statements)

References 5 publications

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“…However, it is our opinion that a course of prophylactic pre‐ and post‐transplant PLX particularly in young males with rapid progression to ESRD may be able to prevent and/or delay the recurrence. In case of recurrence, our experience [39] and that of others [28] suggest that administration of ACE inhibitors along with protracted PLX treatment can induce or maintain the remission.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of renal transplantation in adults with focal segmental glomerulosclerosis

Moroni¹,

Gallelli²,

Quaglini³

et al. 2010

Transplant International

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Summary Little information is available about the long‐term results of kidney transplantation in adults with focal segmental glomerulosclerosis (FSGS). The outcomes of 52 renal transplants performed between 1988 and 2008 in 47 adults with FSGS were compared with those of 104 matched controls (median follow‐up 93.4 vs. 109.4 months respectively). At 15 years, patient survival was 100% and graft survival 56% in FSGS patients vs. 88.3% and 64% respectively in controls (P = NS). FSGS recurred in 12 out of 52 grafts (23%) and led to graft failure in seven within 10 months (median). In the other five cases, proteinuria remitted and grafts are functioning 106 months (median) after transplantation. A second recurrence developed in five out of eight re‐transplanted patients (62.5%) who lost their first graft because of recurrence; only one graft was lost. Patients with recurrence were more frequently male subjects (83% vs. 40%, P = 0.02), younger at diagnosis of FSGS (16.3 ± 6.8 vs. 24.1 ± 11.5 years, P = 0.03) and of younger age at transplantation (28.4 ± 7.8 vs. 35.8 ± 12.2 years, P = 0.05). Treatment with plasmapheresis plus ACE inhibitors achieved either complete or partial remission in 80% of the cases. Long‐term patient and renal allograft survivals of adults with FSGS were comparable to those of controls. Recurrence was more frequent in young patients and in patients who lost a previous graft from recurrence. Graft loss resulting from a second recurrence is lower than expected.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome of renal transplantation in adults with focal segmental glomerulosclerosis

Moroni¹,

Gallelli²,

Quaglini³

et al. 2010

Transplant International

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“…The treatment is focused primarily on the primary disease (e.g. plasmapheresis in FSGS), however antihypertensive therapy, especially with ACE-inhibitors are believed to influence positively the course of recurrent or de novo renal disease in the graft [64,65].…”

Section: Recurrent or De Novo Renal Diseasementioning

confidence: 99%

Hypertension in Children After Renal Transplantation

Seeman

2007

CHYR

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Hypertension is a serious complication in children after renal transplantation, it is an important risk factor not only for graft loss but also for cardiovascular morbidity and mortality of transplanted patients. The etiology of posttransplant hypertension is multifactorial -pretransplant hypertension, damaged native kidneys, immunosuppressive therapy (steroids, cyclosporine, tacrolimus), renal graft artery stenosis and chronic allograft nephropathy are the most common causes. Ambulatory blood pressure monitoring (ABPM) is the best method for blood pressure (BP) evaluation in children after renal transplantation, it often discloses especially night-time hypertension. The prevalence of posttransplant hypertension ranges between 60-90% depending on the method of BP measurement and definition of hypertension. Left ventricular hypertrophy (LVH) is a frequent end-organ damage in hypertensive children after renal transplantation occurring in 50-80% of them. All classes of antihypertensive drugs are used in the treatment of posttransplant hypertension, it has never been proven that one class would be better than another in BP lowering effects or in slowing the progressive loss of graft function associated with chronic allograft nephropathy. Control of hypertension in transplanted children is pooronly 20-50% of treated children have normal BP. The reason for this poor BP control seems to be an inadequate antihypertensive therapy rather than a true resistance of posttransplant hypertension. The unsatisfactorily low control of hypertension can be improved by increasing the number of antihypertensive drugs, especially of angiotensin converting enzyme inhibitors and diuretics. Reduction or elimination of steroids, cyclosporine or tacrolimus is able to reduce BP in transplanted children, however, it could be associated with a risk of acute rejection. Nephrectomy of the diseased native kidneys also decreases BP in transplanted patients but it is performed very rarely in children. There is still a great potential for improvement of antihypertensive treatment that could result in improvement of both graft as well as patient survival in children after renal transplantation.

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Hypertension after renal transplantation

Seeman

2009

Pediatr Nephrol

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Hypertension is a common and serious complication after renal transplantation. It is an important risk factor for graft loss and morbidity and mortality of transplanted children. The etiology of posttransplant hypertension is multifactorial: native kidneys, immunosuppressive therapy, renal-graft artery stenosis, and chronic allograft nephropathy are the most common causes. Blood pressure (BP) in transplanted children should be measured not only by casual BP (CBP) measurement but also regularly by ambulatory BP monitoring (ABPM). The prevalence of posttransplant hypertension ranges between 60% and 90% depending on the method of BP measurement and definition. Left ventricular hypertrophy is a frequent type of end-organ damage in hypertensive children after transplantation (50-80%). All classes of antihypertensive drugs can be used in the treatment of posttransplant hypertension. Hypertension control in transplanted children is poor; only 20-50% of treated children reach normal BP. The reason for this poor control seems to be inadequate antihypertensive therapy, which can be improved by increasing the number of antihypertensive drugs. Improved hypertension control leads to improved long-term graft and patient survival in adults. In children, there is a great potential for antihypertensive treatment that could also result in improved graft and patient survival.

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Double recurrence of FSGS after two renal transplants with complete regression after plasmapheresis and ACE inhibitors

Cited by 14 publications

References 5 publications

Long-term outcome of renal transplantation in adults with focal segmental glomerulosclerosis

Long-term outcome of renal transplantation in adults with focal segmental glomerulosclerosis

Hypertension in Children After Renal Transplantation

Hypertension after renal transplantation

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