Long-term plasmapheresis and protein A column treatment of recurrent FSGS

Belson, Amir; Yorgin, Peter D.; Al‐Uzri, Amira; Salvatierra, Oscar; Higgins, Julian P T; Alexander, Steven R.

doi:10.1007/s004670100008

Cited by 31 publications

(5 citation statements)

References 22 publications

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“…Cases and series have suggested that plasma absorption with protein A is effective at reducing proteinuria, and some authors have advocated the use of plasma absorption as an adjunctive treatment to PP, but data in support of this hypothesis are still limited (37, 38). According to a retrospective study of 11 patients with recurrent FSGS, double diffusion PP was able to reduce proteinuria in 7 cases, but its potential benefit over traditional PP needs further evaluation (35).…”

Section: Treatment Of Fsgs Recurrencementioning

confidence: 99%

Recent Progress in the Pathophysiology and Treatment of FSGS Recurrence

Cravedi

Kopp

Remuzzi

2013

American Journal of Transplantation

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Focal segmental glomerulosclerosis (FSGS) is a glomerular disease characterized by proteinuria, frequent progression to end-stage renal disease, and recurrence after kidney transplantation in ~25% of patients, which negatively impacts long-term allograft survival. Experimental studies suggest that abnormalities in T and, possibly, B cells may represent one initial pathogenic trigger, leading to podocyte injury and progressive loss. New data also support the existence of circulating permeability factors able to damage the podocytes, but no single molecule has been consistently identified as the causal pathogenic element in FSGS recurrence. Unfortunately, major progress from mechanistic studies has not translated into substantial advancements in patient treatment, with plasmapheresis (PP) and high doses of cyclosporine (CsA) remaining the mainstays of therapy. Despite consistent experimental and clinical evidence that treatment of proteinuria slows renal function decline in proteinuric nephropathies, maximal use of antiproteinuric agents such as renin angiotensin system antagonists is not routine in the management of FSGS recurrence. More recently, encouraging results have been reported with anti-CD20 depleting antibody rituximab, but further studies are needed to establish its safety/efficacy profile.

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Section: Treatment Of Fsgs Recurrencementioning

confidence: 99%

Recent Progress in the Pathophysiology and Treatment of FSGS Recurrence

Cravedi

Kopp

Remuzzi

2013

American Journal of Transplantation

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“…This response adds support to the concept of removal of an injurious substance. Unfortunately, there is still a high risk for recurrence and repeated plasmapheresis treatments or other therapies may be required to prevent proteinuria and to prolong allograft function [52] , [57] . Encouragement regarding potential the efficacy of pretransplant immunotherapy comes from a trial in which transplant patients received hematopoietic donor cells following a nonablative preconditioning regimen.…”

Section: Insights From Post-transplant Recurrence Of Nephrotic Syndromentioning

confidence: 99%

Permeability factors in nephrotic syndrome and focal segmental glomerulosclerosis

Savin¹,

McCarthy²,

Sharma³

2012

Kidney Research and Clinical Practice

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Circulating permeability factors have been identified in the plasma of patients with focal segmental glomerulosclerosis (FSGS). Post-transplant recurrence of proteinuria, improvement of proteinuria after treatment with plasmapheresis, and induction of proteinuria in experimental animals by plasma fractions each provide evidence for such plasma factors. Advanced proteomic methods have identified candidate molecules in recurrent FSGS. We have proposed cardiotrophin-like cytokine-1 as an active factor in FSGS. Another potential permeability factor in FSGS is soluble urokinase receptor. In our studies, in vitro plasma permeability activity is blocked by substances that may decrease active molecules or block their effects. We have shown that the simple sugar galactose blocks the effect of FSGS serum in vitro and decreases permeability activity when administered to patients. Since the identities of permeability factors and their mechanisms of action are not well defined, treatment of FSGS is empiric. Corticosteroids are the most common agents for initial treatment. Calcineurin inhibitors, such as cyclosporine A, and tacrolimus and immunosuppressive medications, including mycophenylate, induce remission is some patients with steroid-resistant or -dependent nephrotic syndrome. Therapies that diminish proteinuria and slow progression in FSGS as well as other conditions include renin-angiotensin blockade, blood pressure lowering and plasma lipid control. Use of findings from in vitro studies, coupled with definitive identification of pathogenic molecules, may lead to new treatments to arrest FSGS progression and prevent recurrence after transplantation.

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“…They concluded these results were less than previous reports[ 122 ], while others denied any benefits for the prophylactic PE[ 121 , 123 ]. A combination of PE and immunosuppressive agents has been proposed with limited data[ 124 , 125 ].…”

Section: Treatment Of Recurrent Fsgsmentioning

confidence: 99%

Recurrence of primary glomerulonephritis: Review of the current evidence

Abbas¹,

Kossi

Jin

et al. 2017

WJT

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In view of the availability of new immunosuppression strategies, the recurrence of allograft glomerulonephritis (GN) are reported to be increasing with time post transplantation. Recent advances in understanding the pathogenesis of the GN recurrent disease provided a better chance to develop new strategies to deal with the GN recurrence. Recurrent GN diseases manifest with a variable course, stubborn behavior, and poor response to therapy. Some types of GN lead to rapid decline of kidney function resulting in a frustrating return to maintenance dialysis. This subgroup of aggressive diseases actually requires intensive efforts to ascertain their pathogenesis so that strategy could be implemented for better allograft survival. Epidemiology of native glomerulonephritis as the cause of end-stage renal failure and subsequent recurrence of individual glomerulonephritis after renal transplantation was evaluated using data from various registries, and pathogenesis of individual glomerulonephritis is discussed. The following review is aimed to define current protocols of the recurrent primary glomerulonephritis therapy.

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Long-term plasmapheresis and protein A column treatment of recurrent FSGS

Cited by 31 publications

References 22 publications

Recent Progress in the Pathophysiology and Treatment of FSGS Recurrence

Recent Progress in the Pathophysiology and Treatment of FSGS Recurrence

Permeability factors in nephrotic syndrome and focal segmental glomerulosclerosis

Recurrence of primary glomerulonephritis: Review of the current evidence

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