Recurrence of focal segmental glomerulosclerosis in transplanted kidneys: Analysis of incidence and risk factors in 59 allografts
- 76 Downloads
Fifty-nine allografts were placed in 43 patients with renal failure from focal segmental glomerulosclerosis (FSGS): 27 allografts were put into 16 children aged less than 15 years, and 32 allografts into 27 adolescents and adults. Recurrence of FSGS was noted histologically in 13 allografts, 10 in 8 children and 3 in adults. None of the 9 children and 24 adults who never developed an allograft nephrotic syndrome showed FSGS in their allograft biopsies. The age of onset was a strong risk factor for recurrence: recurrent FSGS developed in 8 of 16 children (50%) but only in 11% of adolescents and adults (3 of 27 patients). Although the time from apparent onset to renal replacement treatment was shorter in those with recurrence than those without in the children, there was no difference in the time spent on dialysis prior to transplantation. Mesangial prominence was observed in the original biopsy in 12 of 13 patients with recurrence, and recurrence rate was similar in living and cadaver donor allografts; class I MHC matching was similar in those with and without recurrence. Three allografts treated with cyclosporin A as well as 9 with azathioprine showed recurrence. Of 9 second or subsequent allografts placed in those with recurrence in the first allograft, only 3 showed further recurence. rence. In 3 re-grafted after 13, 11 and 5 years, normal function was seen.
Key wordsRenal transplantation Recurrent glomerulonephritis Focal segmental glomerulosclerosis Cyclosporin A Nephrotic syndrome
Unable to display preview. Download preview PDF.
- 9.Maizel SE, Sibley RK, Horstman JP, Kjellstrand CM (1981) Incidence and significance of recurrent focal segmental glomerulosclerosis in renal allograft recipients. Transplantation 32:511–516Google Scholar
- 16.Tornroth T (1984) Recurrent and de novo glomerulonephritis in allografted kidneys: aspects of ultrastructural diagnosis. Appl Pathol 5:88–94Google Scholar
- 18.Striegel JE, Sibley RK, Fryd DS, Mauer SM (1986) Recurrence of focal segmental sclerosis in children following renal transplantation. Kidney Int 29 [Suppl 19] S-44–S-50Google Scholar
- 23.Habib R, Bois E (1975) Congenital and infantile nephrotic syndrome. In: Strauss J (ed) Pediatric nephrology, vol. 2. Stratton Intercontinenta, New York, pp 355Google Scholar
- 24.Donckerwolcke RA, Broyer M, Brunner FP, Brynger H, Jacobs C, Kramer P, Selwood NH, Wing AJ (1982) Combined report on regular dialysis and tranplantation of children in Europe, XI, 1981. Proc Eur Dial Transplant Assoc 19:61–86Google Scholar
- 25.Munoz J, Sanchez R, Perez Garcia R, Anaya F, Valderrabano F (1985) Recurrent focal segmental glomerulosclerosis in renal transplants. Proteinuria relapsing following plasma exchange. Clin Nephrol 24:213–214Google Scholar
- 29.Voets AJ, Hoitsma AJ, Koene RAP (1986) Recurrence of nephrotic syndrome during cyclosporin treatment after renal transplantation. Lancet I:266–267Google Scholar
- 30.Pirson Y, Squifflet JP, Marbaix E, Alexandre GP, van Ypersele de Strihou C (1986) Recurrence of focal glomerulosclerosis despite cyclosporine treatment after renal transplantation. Br Med J 292:1336Google Scholar
- 34.Fine RN, Tejani A (1987) Renal transplantation in children. Nephron 47:87–96Google Scholar