Plasmapheresis and Dipyridamole for Recurrent Focal Glomerular Sclerosis

Abstract

A 38-year-old man had recurrence of nephrotic syndrome with focal glomerular sclerosis (FGS) in two consecutive cadaveric renal allografts. His first graft was lost to recurrent disease after 30 months. Because prior animal experiments performed when he had his first graft indicated a possible serum factor or factors capable of enhancing urine protein excretion, three plasmapheresis periods of 6–8 treatments each were performed 3,23 and 34 months after recurrence of FGS in the second graft. Urine protein excretion was decreased transiently in the first treatment period when the allograft biopsy revealed only glomerular foot process effacement. The second and third plasmapheresis treatment periods were performed after typical lesions of FGS were present in the graft and moderate renal insufficiency occurred. Dipyridamole was also given at this time. There has been associated stabilization of renal function for over 31 months. Prior to this, renal function was significantly (p < 0.001) decreasing with time. The reasons for stabilization of renal function in this man with recurrent FGS are not defined, but the results suggest the need to further evaluate plasmapheresis and the platelet inhibitor dipyridamole in native and recurrent FGS.

Apheresis treatment of recurrent focal segmental glomerulosclerosis after kidney transplantation: Re‐analysis of published case‐reports and case‐series

“…There are few data on treatment of second or third recurrence of FSGS in the transplant kidney. However, several case reports indicate that response to apheresis in subsequent relapse may be as good as with ®rst relapse [4,10,13].…”

“…In addition, apheresis appears to have a long-term positive eect. Protein excretion can continue to decline even after conclusion of apheresis [6,12,13]. However, it is important to adapt the apheresis regimen to the patient's clinical response.…”

The Urinary Podocyte as a Marker for the Differential Diagnosis of Idiopathic Focal Glomerulosclerosis and Minimal-Change Nephrotic Syndrome

“…A circulating humoral factor may be involved in the pathogenesis of FGS in some cases [18,19]. In a number of studies, plasmapheresis has been shown to have a beneficial effect in patients with recurrent FGS after renal transplantation [18][19][20].…”

“…In a number of studies, plasmapheresis has been shown to have a beneficial effect in patients with recurrent FGS after renal transplantation [18][19][20]. Recently, Feld et al [1] have reported that plasmapheresis diminished proteinuria and stabilized renal function in a small group of patients with steroid-resistant idiopathic FGS.…”

Update on the treatment of focal segmental glomerulosclerosis in renal transplantation

“…Despite research into this causative factor remaining in a status of "cold case", PE is still a cornerstone in FSGS recurrence treatment, since the 1985 report of its first positive application by Zimmerman [30] . A systematic review by Ponticelli [4] showed that PE promotes partial or complete remission in 70% of children and 63% of adults with FSGS recurrence.…”