Management of recurrent focal segmental glomerulosclerosis (FSGS) post renal transplantation

Shamsi, Hefsa Rashed Al; Shaheen, Ihab Sakr; Aziz, David

doi:10.1016/j.trre.2021.100675

Cited by 6 publications

(3 citation statements)

References 60 publications

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“…Prophylactic pre-transplant rituximab might even play a role in preventing FSGS recurrence ( 58 – 60 ), while results with plasmapheresis are contrasting in the pre-transplantation setting. However, due to inconsistent results and the lack of randomized controlled trials, the use of pre-transplant therapy to reduce the risk of disease recurrence is not recommended and should be avoided ( 54 , 61 ).…”

Section: Clinical Course and Treatment Of Focal Segmental Glomerulosc...mentioning

confidence: 99%

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

Salfi,

Casiraghi,

Remuzzi

2023

Front. Immunol.

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The pathogenetic mechanisms underlying the onset and the post-transplant recurrence of primary focal segmental glomerulosclerosis (FSGS) are complex and remain yet to be fully elucidated. However, a growing body of evidence emphasizes the pivotal role of the immune system in both initiating and perpetuating the disease. Extensive investigations, encompassing both experimental models and patient studies, have implicated T cells, B cells, and complement as crucial actors in the pathogenesis of primary FSGS, with various molecules being proposed as potential “circulating factors” contributing to the disease and its recurrence post kidney-transplantation. In this review, we critically assessed the existing literature to identify essential pathways for a comprehensive characterization of the pathogenesis of FSGS. Recent discoveries have shed further light on the intricate interplay between these mechanisms. We present an overview of the current understanding of the engagement of distinct molecules and immune cells in FSGS pathogenesis while highlighting critical knowledge gaps that require attention. A thorough characterization of these intricate immune mechanisms holds the potential to identify noninvasive biomarkers that can accurately identify patients at high risk of post-transplant recurrence. Such knowledge can pave the way for the development of targeted and personalized therapeutic approaches in the management of FSGS.

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Section: Clinical Course and Treatment Of Focal Segmental Glomerulosc...mentioning

confidence: 99%

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

Salfi,

Casiraghi,

Remuzzi

2023

Front. Immunol.

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“…While other reports showed total failure of rituximab in inducing remission ( 43 – 45 ). Moreover, the dose of rituximab used to treat NS recurrence is variable according to the centers and represents a further confounding factor in interpreting previous reports: dose administered ranges from single infusion at low-dose of 100 mg to 2 monthly infusions of 1 gr, according to the centers’ protocols ( 46 ).…”

Section: Monoclonal Anti-cd20 Antibodiesmentioning

confidence: 99%

Biologics in steroid resistant nephrotic syndrome in childhood: review and new hypothesis-driven treatment

Angeletti,

Bruschi,

Kajana

et al. 2023

Front. Immunol.

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Nephrotic syndrome affects about 2–7 per 100,000 children yearly and accounts for less than 15% of end stage kidney disease. Steroids still represent the cornerstone of therapy achieving remission in 75–90% of the cases The remaining part result as steroid resistant nephrotic syndrome, characterized by the elevated risk of developing end stage kidney disease and frequently presenting disease recurrence in case of kidney transplant. The pathogenesis of nephrotic syndrome is still far to be elucidated, however, efficacy of immune treatments provided the basis to suggest the involvement of the immune system in the pathogenesis of the disease. Based on these substrates, more immune drugs, further than steroids, were administered in steroid resistant nephrotic syndrome, such as antiproliferative and alkylating agents or calcineurin inhibitors. However, such treatments failed in inducing a sustained remission. In last two decades, the developments of monoclonal antibodies, including the anti-CD20 rituximab and inhibitor of B7-1 abatacept, represented a valid opportunity of treatment. However, also the effectiveness of biologics resulted limited. We here propose a new hypothesis-driven treatment based on the combining administration of rituximab with the anti-CD38 monoclonal antibody daratumumab (NCT05704400), sustained by the hypothesis to target the entire B-cells subtypes pool, including the long-lived plasmacells.

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“…Once proteinuria reappears, it is recommended to start PE immediately. A review summarized data from 23 studies and found prophylactic PE did not show a reduction in recurrence of FSGS in two thirds of the studies [ 121 ].…”

Section: Ta In Kidney Transplantationmentioning

confidence: 99%

Therapeutic apheresis in kidney diseases: an updated review

et al. 2022

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Besides conventional medical therapies, therapeutic apheresis has become an important adjunctive or alternative therapeutic option to immunosuppressive agents for primary or secondary kidney diseases and kidney transplantation. The available therapeutic apheresis techniques used in kidney diseases, including plasma exchange, double-filtration plasmapheresis, immunoadsorption, and low-density lipoprotein apheresis. Plasma exchange is still the leading extracorporeal therapy. Recently, growing evidence supports the potential benefits of double-filtration plasmapheresis and immunoadsorption for more specific and effective clearance of pathogenic antibodies with fewer side effects. However, more randomized controlled trials are still needed. Low-density lipoprotein apheresis is also an important supplementary therapy used in patients with recurrent focal segmental glomerulosclerosis. This review collects the latest evidence from recent studies, focuses on the specific advantages and disadvantages of these techniques, and compares the discrepancy among them to determine the optimal therapeutic regimens for certain kidney diseases.

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Management of recurrent focal segmental glomerulosclerosis (FSGS) post renal transplantation

Cited by 6 publications

References 60 publications

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

Biologics in steroid resistant nephrotic syndrome in childhood: review and new hypothesis-driven treatment

Therapeutic apheresis in kidney diseases: an updated review

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