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Bai J, Yin X, Li J, Li JQ, Niu Y, Li Z, Li J, Zhou Y. Incidence, risk factors, and outcomes of recurrent focal segmental glomerulosclerosis in pediatric kidney transplant recipients: A systematic review and meta-analysis. Clin Transplant 2023; 37:e15119. [PMID: 37725070 DOI: 10.1111/ctr.15119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Focal segmental glomerulosclerosis is the most prevalent acquired kidney disease leading to end-stage renal disease in children and has a propensity for recurring in the transplanted kidney. The recurrence of FSGS after kidney transplantation in children varies greatly. In addition, the risk factors and outcomes of recurrence of FSGS remain controversial. This study evaluated the recurrence rate, risk factors, and prognosis of FSGS after kidney transplantation in order to provide advice and assistance in clinical decision-making for pediatric kidney transplantation. METHODS PubMed, Embase, Web of Science, CNKI, and other databases were searched from the establishment of the repository to March 2022. We extracted data on incidence, risk factors, and outcomes. RESULTS The results showed that the recurrence rate of primary FSGS in children after renal transplantation was 48% (95% CI 36%-59%) and the recurrence rate of FSGS (all forms) was 35% (95% CI 17%-52%). The graft loss rate of primary FSGS in children after kidney transplantation was 29% (95% CI 17%-42%) and the graft loss rate of FSGS (all forms) was 29% (95% CI 4%-62%). 57% (95% CI 42%-73%) of pediatric patients with recurrent primary FSGS showed complete remission. Risk factor analyses showed that age of onset (SMD .69, 95% CI .20-1.19, p = .006) was related to the recurrence of primary FSGS, whereas the living related donor was not a risk factor for recurrent primary FSGS in pediatrics after kidney transplantation (OR 1.22, 95% CI .48-3.10, p = .674). CONCLUSIONS The recurrence rate and graft loss rate of FSGS in children after kidney transplantation were relatively high. Age at onset was associated with a risk for recurrent primary FSGS, whereas the living related donor was not a risk factor for recurrent FSGS in pediatric kidney recipients.
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Affiliation(s)
- Jiang Bai
- Department of Nephrology, Shanxi Provincial People's Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xinyu Yin
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jiaqi Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jia-Qi Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yanna Niu
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhenhua Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jing Li
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yun Zhou
- Department of Nephrology, Shanxi Provincial People's Hospital (Fifth Hospital) of Shanxi Medical University, Taiyuan, Shanxi, China
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2
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Uffing A, Hullekes F, Riella LV, Hogan JJ. Recurrent Glomerular Disease after Kidney Transplantation: Diagnostic and Management Dilemmas. Clin J Am Soc Nephrol 2021; 16:1730-1742. [PMID: 34686531 PMCID: PMC8729409 DOI: 10.2215/cjn.00280121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Recurrent glomerular disease after kidney transplant remains an important cause of allograft failure. Many of the different entities post-transplant still suffer from incomplete knowledge on pathophysiology, and therefore lack targeted and effective therapies. In this review, we focus on specific clinical dilemmas encountered by physicians in managing recurrent glomerular disease by highlighting new insights into the understanding and treatment of post-transplant focal segmental glomerulosclerosis, membranous nephropathy, atypical hemolytic uremic syndrome, C3 glomerulopathy, amyloid light-chain (AL) amyloidosis, and IgA nephropathy.
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Affiliation(s)
- Audrey Uffing
- Renal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Hullekes
- Renal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Leonardo V. Riella
- Renal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,Department of Surgery, Center for Transplantation Sciences, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan J. Hogan
- Division of Renal Electrolyte and Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Trautmann A, Vivarelli M, Samuel S, Gipson D, Sinha A, Schaefer F, Hui NK, Boyer O, Saleem MA, Feltran L, Müller-Deile J, Becker JU, Cano F, Xu H, Lim YN, Smoyer W, Anochie I, Nakanishi K, Hodson E, Haffner D. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome. Pediatr Nephrol 2020; 35:1529-1561. [PMID: 32382828 PMCID: PMC7316686 DOI: 10.1007/s00467-020-04519-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic nephrotic syndrome newly affects 1-3 per 100,000 children per year. Approximately 85% of cases show complete remission of proteinuria following glucocorticoid treatment. Patients who do not achieve complete remission within 4-6 weeks of glucocorticoid treatment have steroid-resistant nephrotic syndrome (SRNS). In 10-30% of steroid-resistant patients, mutations in podocyte-associated genes can be detected, whereas an undefined circulating factor of immune origin is assumed in the remaining ones. Diagnosis and management of SRNS is a great challenge due to its heterogeneous etiology, frequent lack of remission by further immunosuppressive treatment, and severe complications including the development of end-stage kidney disease and recurrence after renal transplantation. A team of experts including pediatric nephrologists and renal geneticists from the International Pediatric Nephrology Association (IPNA), a renal pathologist, and an adult nephrologist have now developed comprehensive clinical practice recommendations on the diagnosis and management of SRNS in children. The team performed a systematic literature review on 9 clinically relevant PICO (Patient or Population covered, Intervention, Comparator, Outcome) questions, formulated recommendations and formally graded them at a consensus meeting, with input from patient representatives and a dietician acting as external advisors and a voting panel of pediatric nephrologists. Research recommendations are also given.
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Affiliation(s)
- Agnes Trautmann
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Marina Vivarelli
- Department of Pediatric Subspecialties, Division of Nephrology and Dialysis, Bambino Gesù Pediatric Hospital and Research Center, Rome, Italy
| | - Susan Samuel
- Department of Pediatrics, Section of Pediatric Nephrology, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Debbie Gipson
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Aditi Sinha
- Department of Pediatrics, Division of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Ng Kar Hui
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Olivia Boyer
- Laboratory of Hereditary Kidney Diseases, Imagine Institute, INSERM U1163, Paris Descartes University, Paris, France
- Department of Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Necker Hospital, APHP, 75015, Paris, France
| | - Moin A Saleem
- Department of Pediatric Nephrology, Bristol Royal Hospital for Children, University of Bristol, Bristol, UK
| | - Luciana Feltran
- Hospital Samaritano and HRim/UNIFESP, Federal University of São Paulo, São Paulo, Brazil
| | | | - Jan Ulrich Becker
- Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Francisco Cano
- Department of Nephrology, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China
| | - Yam Ngo Lim
- Department of Pediatrics, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - William Smoyer
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Ifeoma Anochie
- Department of Paediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - Koichi Nakanishi
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Elisabeth Hodson
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead and the Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Dieter Haffner
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School Children's Hospital, Hannover, Germany.
- Department of Paediatric Kidney, Liver and Metabolic Diseases, Paediatric Research Center, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
- Center for Rare Diseases, Hannover Medical School Children's Hospital, Hannover, Germany.
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4
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Park E, Lee C, Kim NKD, Ahn YH, Park YS, Lee JH, Kim SH, Cho MH, Cho H, Yoo KH, Shin JI, Kang HG, Ha IS, Park WY, Cheong HI. Genetic Study in Korean Pediatric Patients with Steroid-Resistant Nephrotic Syndrome or Focal Segmental Glomerulosclerosis. J Clin Med 2020; 9:jcm9062013. [PMID: 32604935 PMCID: PMC7355646 DOI: 10.3390/jcm9062013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022] Open
Abstract
Steroid-resistant nephrotic syndrome (SRNS) is one of the major causes of end-stage renal disease (ESRD) in childhood and is mostly associated with focal segmental glomerulosclerosis (FSGS). More than 50 monogenic causes of SRNS or FSGS have been identified. Recently, the mutation detection rate in pediatric patients with SRNS has been reported to be approximately 30%. In this study, genotype-phenotype correlations in a cohort of 291 Korean pediatric patients with SRNS/FSGS were analyzed. The overall mutation detection rate was 43.6% (127 of 291 patients). WT1 was the most common causative gene (23.6%), followed by COQ6 (8.7%), NPHS1 (8.7%), NUP107 (7.1%), and COQ8B (6.3%). Mutations in COQ6, NUP107, and COQ8B were more frequently detected, and mutations in NPHS2 were less commonly detected in this cohort than in study cohorts from Western countries. The mutation detection rate was higher in patients with congenital onset, those who presented with proteinuria or chronic kidney disease/ESRD, and those who did not receive steroid treatment. Genetic diagnosis in patients with SRNS provides not only definitive diagnosis but also valuable information for decisions on treatment policy and prediction of prognosis. Therefore, further genotype-phenotype correlation studies are required.
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Affiliation(s)
- Eujin Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (E.P.); (Y.H.A.); (H.G.K.); (I.-S.H.)
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea
| | - Chung Lee
- Samsung Genome Institute, Samsung Medical Center, Seoul 06351, Korea; (C.L.); (N.K.D.K.); (W.-Y.P.)
- GENINUS Inc., Seoul 05836, Korea
| | - Nayoung K. D. Kim
- Samsung Genome Institute, Samsung Medical Center, Seoul 06351, Korea; (C.L.); (N.K.D.K.); (W.-Y.P.)
- GENINUS Inc., Seoul 05836, Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (E.P.); (Y.H.A.); (H.G.K.); (I.-S.H.)
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.S.P.); (J.H.L.)
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul 05505, Korea; (Y.S.P.); (J.H.L.)
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea;
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu 41944, Korea;
| | - Heeyeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Kee Hwan Yoo
- Department of Pediatrics, Korea University Guro Hospital, Seoul 02841, Korea;
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea;
- Division of Pediatric Nephrology, Severance Children’s Hospital, Seoul 03722, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (E.P.); (Y.H.A.); (H.G.K.); (I.-S.H.)
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (E.P.); (Y.H.A.); (H.G.K.); (I.-S.H.)
| | - Woong-Yang Park
- Samsung Genome Institute, Samsung Medical Center, Seoul 06351, Korea; (C.L.); (N.K.D.K.); (W.-Y.P.)
- GENINUS Inc., Seoul 05836, Korea
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon 16419, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea; (E.P.); (Y.H.A.); (H.G.K.); (I.-S.H.)
- Correspondence: ; Tel.: +82-2-2072-2810
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5
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Auñón P, Polanco N, Pérez-Sáez MJ, Rodrigo E, Sancho A, Pascual J, Andrés A, Praga M. Pre-emptive rituximab in focal and segmental glomerulosclerosis patients at risk of recurrence after kidney transplantation. Clin Kidney J 2019; 14:139-148. [PMID: 33564412 PMCID: PMC7857812 DOI: 10.1093/ckj/sfz120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Background The recurrence of proteinuria after kidney transplantation (KT) is a characteristic complication of focal segmental glomerulosclerosis (FSGS). It has been suggested that pre-emptive rituximab might prevent recurrences in patients at risk, but there is no agreement about which factors might help to identify such patients. Methods We studied 93 kidney transplants with biopsy-proven idiopathic FSGS in order to analyse if preventive rituximab treatment could decrease recurrences in patients at risk. Results Fifteen patients (16.1%) presented a recurrence after KT, but when we restricted the analysis to the 34 patients presenting nephrotic syndrome at primary disease onset, the recurrence diagnosis rate increased to 44.1%. All patients with recurrence had complete nephrotic syndrome at the time of diagnosis. After multivariate adjustment, the only significant risk factor for recurrence was the presence of complete nephrotic syndrome at diagnosis. Twelve of the 34 patients at risk for recurrence received rituximab at the time of transplantation. Clinical and analytical characteristics were similar in all patients at risk. The number of recurrences was similar among treated (50%) and non-treated patients (40.9%). Conclusions Nephrotic syndrome with hypoalbuminaemia at diagnosis is the most important feature to identify patients at risk of recurrence. Our data suggest that pre-emptive rituximab is not effective to prevent FSGS recurrences.
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Affiliation(s)
- Pilar Auñón
- Nephrology Department, Hospital Doce de Octubre, Madrid, Spain
| | - Natalia Polanco
- Nephrology Department, Hospital Doce de Octubre, Madrid, Spain
| | | | - Emilio Rodrigo
- Nephrology Department, Hospital Marqués de Valdecilla, Santander, Spain
| | - Asunción Sancho
- Nephrology Department, Hospital Doctor Peset, Valencia, Spain
| | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Amado Andrés
- Nephrology Department, Hospital Doce de Octubre, Madrid, Spain
| | - Manuel Praga
- Nephrology Department, Hospital Doce de Octubre, Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
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6
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Francis A, Didsbury M, McCarthy H, Kara T. Treatment of recurrent focal segmental glomerulosclerosis post-kidney transplantation in Australian and New Zealand children: A retrospective cohort study. Pediatr Transplant 2018; 22:e13185. [PMID: 29676031 DOI: 10.1111/petr.13185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/27/2022]
Abstract
Disease recurrence affects around a third of renal transplants for children with FSGS and is associated with poor graft outcomes. Unfortunately, there are no large trials guiding treatment for recurrent FSGS. We aimed to describe current therapies and treatment response for recurrent FSGS in 4 centres in Australia and New Zealand. Data were collected on children (age <18 years) with recurrent FSGS (1990-2015). We reviewed patient charts to obtain clinical information. Ethics approval was obtained from the relevant boards. Complete records were available on 24 patients (62% female, 54% Caucasian). Median time to first recurrence was 4 days (IQR 2-5 days). There were 14 separate treatment regimens, involving an average of 2 agents. The most common therapies were plasma exchange (20/24 patients, 83%), cyclosporin (15/24, 63%), and methylprednisolone (9/24, 38%). Full remission was achieved in 15 (63%), partial remission in 2 (8%), and no remission in 7 (29%) patients. Of the patients with no remission, 5 lost their graft to recurrent disease and 1 to concurrent acute vascular rejection. The plethora of different treatment regimens reflects the poor evidence guiding management for recurrent FSGS. More research is needed to improve outcomes.
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Affiliation(s)
- Anna Francis
- Child and Adolescent Renal Services, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia.,Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia
| | - Madeleine Didsbury
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia
| | - Hugh McCarthy
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia.,Paediatric Nephrology, Sydney Children's Hospitals Network, Sydney, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Tonya Kara
- Centre for Kidney Research, University of Sydney, Sydney, NSW, Australia.,Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
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Kang HG, Seo H, Lim JH, Kim JI, Han KH, Park HW, Koo JW, Kim KH, Kim JH, Cheong HI, Ha IS. Markers of disease and steroid responsiveness in paediatric idiopathic nephrotic syndrome: Whole-transcriptome sequencing of peripheral blood mononuclear cells. J Int Med Res 2017. [PMID: 28639503 PMCID: PMC5536413 DOI: 10.1177/0300060516652762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To identify markers of disease and steroid responsiveness in paediatric idiopathic nephrotic syndrome. Methods Whole-transcriptome sequencing was performed of peripheral blood mononuclear cells (PBMCs) from patients with NS. Differentially expressed genes (DEGs) were identified in patients with active NS vs those in remission, and those with steroid-sensitive NS (SSNS) vs steroid-resistant NS (SRNS). Results A total of 1065 DEGs were identified in patients with NS (n = 10) vs those in remission (n = 9). These DEGs correlated with cytokine and/or immune system signalling and the extracellular matrix. Comparisons between SSNS (n = 6) and SRNS (n = 4) identified 1890 DEGs. These markers of steroid responsiveness were enriched with genes related to the cell cycle, targets of microRNAs, and genes related to cytokines. Conclusions Meaningful DEGs were identified. Additional studies with larger numbers of patients will provide more comprehensive data.
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Affiliation(s)
- Hee Gyung Kang
- 1 Department of Paediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,2 Research Coordination Centre for Rare Diseases, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heewon Seo
- 3 Seoul National University Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.,4 Systems Biomedical Informatics Research Centre, Seoul National University, Seoul, Republic of Korea
| | - Jae Hyun Lim
- 3 Seoul National University Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.,4 Systems Biomedical Informatics Research Centre, Seoul National University, Seoul, Republic of Korea
| | - Jong Il Kim
- 5 Genomic Medicine Institute, Seoul National University, Seoul, Republic of Korea
| | - Kyoung Hee Han
- 6 Department of Paediatrics, Jeju University Hospital, Jeju, Korea
| | - Hye Won Park
- 7 Department of Paediatrics, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ja Wook Koo
- 8 Department of Paediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Kee Hyuck Kim
- 9 Department of Paediatrics, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Ju Han Kim
- 3 Seoul National University Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.,4 Systems Biomedical Informatics Research Centre, Seoul National University, Seoul, Republic of Korea
| | - Hae Il Cheong
- 1 Department of Paediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,2 Research Coordination Centre for Rare Diseases, Seoul National University Hospital, Seoul, Republic of Korea.,10 Kidney Research Institute, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il-Soo Ha
- 1 Department of Paediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,10 Kidney Research Institute, Medical Research Centre, Seoul National University College of Medicine, Seoul, Republic of Korea
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8
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Cleper R, Krause I, Bar Nathan N, Mor M, Dagan A, Weissman I, Frishberg Y, Rachamimov R, Mor E, Davidovits M. Focal segmental glomerulosclerosis in pediatric kidney transplantation: 30 years’ experience. Clin Transplant 2016; 30:1324-1331. [DOI: 10.1111/ctr.12825] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Roxana Cleper
- Pediatric Nephrology Unit; Tel Aviv Sourasky Medical Center; Dana Dwek Children's Hospital; Tel Aviv Israel
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petah Tikva Israel
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
| | - Irit Krause
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petah Tikva Israel
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- Pediatric Department C; Schneider Children's Medical Center of Israel; Petah Tikva Israel
| | - Nathan Bar Nathan
- Department of Transplantation; Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Maya Mor
- Department of Transplantation; Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Amit Dagan
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petah Tikva Israel
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
| | - Irith Weissman
- Department of Pediatric Nephrology and Dialysis; Western Galilee Hospital; Nahariya Israel
- The Faculty of Medicine in the Galilee; Bar Ilan University; Safed Israel
| | - Yaakov Frishberg
- Division of Pediatric Nephrology; Shaare Zedek Medical Center; Jerusalem Israel
- Hadassah-Hebrew University School of Medicine; Jerusalem Israel
| | - Ruty Rachamimov
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- Department of Transplantation; Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Eitan Mor
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
- Department of Transplantation; Rabin Medical Center; Beilinson Hospital; Petah Tikva Israel
| | - Miriam Davidovits
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petah Tikva Israel
- Sackler Medical School; Tel Aviv University; Tel Aviv Israel
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9
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Recurrence and Treatment after Renal Transplantation in Children with FSGS. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6832971. [PMID: 27213154 PMCID: PMC4860214 DOI: 10.1155/2016/6832971] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/14/2016] [Accepted: 04/04/2016] [Indexed: 01/15/2023]
Abstract
Focal segmental glomerulosclerosis (FSGS) is a common cause of end-stage renal disease and a common pathologic diagnosis of idiopathic nephrotic syndrome (NS), especially in steroid-resistant cases. FSGS is known to recur after kidney transplantation, frequently followed by graft loss. However, not all patients with FSGS suffer from recurrence after kidney transplantation, and genetic and secondary FSGS have a negligible risk of recurrence. Furthermore, many cases of recurrence achieve remission with the current management of recurrence (intensive plasmapheresis/immunosuppression, including rituximab), and other promising agents are being evaluated. Therefore, a pathologic diagnosis of FSGS itself should not cause postponement of allograft kidney transplantation. For patients with a high risk of recurrence who presented with classical symptoms of NS, that is, severe edema, proteinuria, and hypoalbuminemia, close monitoring of proteinuria is necessary, followed by immediate, intensive treatment for recurrence.
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