Recurrent focal segmental glomerulosclerosis in the renal allograft: single center experience in the era of modern immunosuppression

Schächter, Michael; Monahan, Michael W.; Crew, John R.; Pollak, Martin R.; Ratner, Lloyd E.; Valeri, A M; Stokes, Michael B.; Appel, Gerald B.

doi:10.5414/cnp74173

Cited by 35 publications

(30 citation statements)

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“…Incidence-effect of recipient race African Americans show a lower incidence of recurrence compared to other races/ethnicities, namely, Caucasian, Hispanic, and Asians [6,7,9]. This is supported by nearly all studies summarized in Table 1 that include data on race/ethnicity.…”

Section: Epidemiologymentioning

confidence: 74%

“…In addition, it can spontaneously resolve without treatment. In the series of patients reported by Schachter et al [9], recurrent FSGS increased the occurrence of death or ESKD from 12 to 27 %. Similarly, in a review of 2,687 adolescents with a kidney transplant enrolled in the North American Pediatric Renal Transplant Collaborative Study (NAPRTCS) database between 1987 and 2001, of whom 338 had primary FSGS, recurrent FSGS accounted for 15 % of all graft failures (17 % in recipients of living related donor kidneys and 14 % in recipients of deceased donor kidneys) [16].…”

Section: Epidemiologymentioning

confidence: 86%

“…Hickson et al [5] provided data for the incidence of recurrent disease for both a clinically based diagnosis of primary FSGS compared to biopsy-proven diagnosis and found the incidence to increase drastically from 55 to 75 % [3]. The majority of studies reported an incidence closer to 25 %; however, these included pediatric and/or adult patients [8][9][10][11]. Trend analysis of data compiled by the United Network for Organ Sharing (UNOS) over the period from 1988-2008 showed an increase in cases of recurrent FSGS by 5.8 % per year [12].…”

Section: Epidemiologymentioning

confidence: 99%

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Recurrent focal segmental glomerulosclerosis after kidney transplantation

2015

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Focal segmental glomerulosclerosis (FSGS) is an important cause of glomerular disease in children and adolescents and nearly 50 % of affected patients will progress to endstage kidney disease over a 5 to 10-year period. Unfortunately, there is no established treatment for disease in the native kidney. Moreover, up to 55 % of patients develop recurrent disease after receiving a kidney transplant, with a substantially higher risk in patients who have already experienced recurrent disease in a prior transplant. A number of clinical and laboratory factors have been identified as risk factors for this complication. In addition, new investigations into podocyte biology and circulating permeability factors have shed light on the cause of recurrent the disease. While a number of novel therapeutic agents have been applied in the management of this problem, there still is no proven treatment. In this review, we summarize recent advances in the epidemiology, pathophysiology, and treatment of recurrent FSGS in pediatric patients who have received a kidney transplant.

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Section: Epidemiologymentioning

confidence: 74%

Section: Epidemiologymentioning

confidence: 86%

Section: Epidemiologymentioning

confidence: 99%

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Recurrent focal segmental glomerulosclerosis after kidney transplantation

2015

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“…New insights may also be forthcoming with regard to the recurrence of focal segmental glomerulosclerosis following kidney transplantation (Box 1). 121,125,126 One of these studies implicated apolipoproteins among the circulating factors that govern recurrent proteinuria following transplantation in focal segmental glomerulosclerosis. Thus, advance knowledge of genotype might guide preparatory therapy (for example, plasmapheresis) for this possible outcome, or suggest new preventive or therapeutic approaches.…”

Section: Discussionmentioning

confidence: 99%

The population genetics of chronic kidney disease: insights from the MYH9–APOL1 locus

Rosset

Tzur

Behar³

et al. 2011

Nat Rev Nephrol

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Many rare kidney disorders exhibit a monogenic, Mendelian pattern of inheritance. Population-based genetic studies have identified many genetic variants associated with an increased risk of developing common kidney diseases. Strongly associated variants have potential clinical uses as predictive markers and may advance our understanding of disease pathogenesis. These principles are elegantly illustrated by a region within chromosome 22q12 that has a strong association with common forms of kidney disease. Researchers had identified DNA sequence variants in this locus that were highly associated with an increased prevalence of common chronic kidney diseases in people of African ancestry. Initial research concentrated on MYH9 as the most likely candidate gene; however, population-based whole-genome analysis enabled two independent research teams to discover more strongly associated mutations in the neighboring APOL1 gene. The powerful evolutionary selection pressure of an infectious pathogen in West Africa favored the spread of APOL1 variants that protect against a lethal form of African sleeping sickness but are highly associated with an increased risk of kidney disease. We describe the data sources, process of discovery, and reasons for initial misidentification of the candidate gene, as well as the lessons that can be learned for future population genetics research.

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“…Other typical PP prescription is 1-2 times plasma volume exchanges (usually 60 ml for every 1 kg body weight per session) and about 3-4 treatments per week until remission is achieved, usually about 10 sessions. Schachter et al found that PP resulted in complete or partial remission in 75% of those with recurrence (3/12 complete and 5/12 partial remission; partial remission was defined when proteinuria was decreased by 50%) and 25% of patients remained dependent on regular plasma exchange to prevent recurrence of proteinuria (55). Prophylactic PP with 8 single-volume treatments over 2 weeks prior to transplantation has been attempted in patients at high risk for recurrence with variable outcome, in case reports success varied from 50% (56) to less significant benefit.…”

Section: Plasmapheresis and Immunoadsorptive Therapiesmentioning

confidence: 99%