Prediction and treatment of recurrent focal segmental glomerulosclerosis after renal transplantation in children

Dall’Amico, Roberto; Ghiggeri, Gian Marco; Carraro, Michele; Artero, Mary; Ghio, Luciana; Zamorani, E.; Zennaro, Cristina; Basile, Giancarlo; Montini, Giovanni; Rivabella, L; Cardillo, Massimo; Scalamogna, M.; Ginevri, Fabrizio

doi:10.1016/s0272-6386(99)70010-7

Cited by 188 publications

(179 citation statements)

References 23 publications

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“…Vári-os autores [14][15][16][17] observaram que quanto mais precoce é a introdução da plasmaférese após a recaída, melhor é a evolução do paciente, sugerindo que quanto mais cedo o "fator humoral" for retirado da circulação menor é o dano glomerular.…”

Section: Discussionunclassified

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura

Moraes¹,

Roveri²,

Oliveira³

et al. 2007

Rev. Bras. Hematol. Hemoter.

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IntroduçãoA glomeruloesclerose segmentar focal (GESF) é uma doença renal caracterizada por síndrome nefrótica, que acomete tanto as crianças quanto os adultos. Aproximadamente 7%-15% de todas as crianças com síndrome nefrótica idiopática, apresentam diagnóstico de GESF à biópsia renal. Quando não tratados, esses pacientes evoluem com proteinúria progressiva, queda da taxa de filtração glomerular e, em até 30% dos casos, progridem para insuficiência renal terminal em cerca de vinte anos. 1 O transplante é o tratamento de escolha para a doença renal terminal. Contudo, o índice de recorrência de GESF é alto, ocorrendo de 30% a 50% dos casos. Nesta situação ocorre recorrência da proteinúria com perda do enxerto de 58% a 80%, além do risco de recorrência de GESF aumentar muito em transplantes subseqüentes, podendo chegar até a 85% dos casos.

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Section: Discussionunclassified

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura

Moraes¹,

Roveri²,

Oliveira³

et al. 2007

Rev. Bras. Hematol. Hemoter.

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“…Possibly the strongest predictor of recurrence is a history of recurrence in a previous transplant. Indeed, the risk of recurrence when there has been a previous allograft failure due to recurrent FSGS may be as high as 80% (274,282,286,291). It has been shown by some investigators that the presence of an abnormal serum protein correlates with FSGS recurrence (286,292,293).…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

“…However, standardized assays are not available for clinical use. There does not appear to be any consistent effect of gender (282,286), the type of prophylactic immunosuppression used (276,277,279) or the time spent on renal replacement therapy before transplantation (276). In one uncontrolled study the use of antibody induction therapy was associated with a higher incidence of recurrent FSGS (287).…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

“…Patients should be warned that graft loss may occur in 40-50% with recurrent FSGS (282,283,286,300). If a living donor is being considered, both the transplant candidate and the potential donor should be aware of the risks.…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

“…The immediate onset of proteinuria after transplantation has also been reported to be a negative prognostic factor (286). Several small, uncontrolled reports suggest that plasma exchange or protein adsorption may induce a remission in some patients with recurrent FSGS (281,289,292,293,(302)(303)(304).…”

Section: The Evaluation Of Renal Transplant Candidates: Clinical Pracmentioning

confidence: 99%

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The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

2001

American Journal of Transplantation

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Inhibition of renal permeability towards albumin: A new function of apolipoproteins with possible pathogenetic relevance in focal glomerulosclerosis

et al. 2001

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Focal segmental glomerulosclerosis (FSGS) is a degenerative renal disease characterized by the accumulation of extracellular matrix and lipids within the glomerular tuft. It has been proposed that an abnormal renal permeabilization towards proteins induced by a putative plasma factor is, in some way, involved in the pathogenesis of the disease. In this paper, we measured the plasma permeability activity (Palb) in several sera of patients with FSGS and found a mean activity of 0.82+/-0.03 which means a marked increase compared to a mean Palb of 0.16+/-0.03 in normal controls. Coincubation of FSGS and normal serum reduced the permeability activity within the normal range; normal serum added to the incubation medium after the glomeruli had already been exposed to the FSGS serum had no effect, suggesting the presence of inhibitory substances with a direct effect on a circulating substrate. Finally, the antipermeability activity was retained when heated to 60 degrees C but not to 100 degrees C. By serial fractionations of normal serum and reported activity measurements at each step, five natural occurring inhibitors of albumin permeabilization were purified and characterized by matrix assisted laser desorption/ionization-mass spectrometry (MALDI-MS), as components of apolipoproteins (apo) (apo E2 and E4, apo L, the high Mr apo J and a 28 kDa fragment of apo A-IV). Coincubation of each apolipoprotein with FSGS serum inhibited permeability, but only apo J and apo E2 and E4 were found to be crucial for the process. In conclusion, we have purified from normal serum five inhibitors of permeability induced by FSGS serum, all corresponding to apolipoproteins. An imbalance between permeability factors and apolipoproteins may play a pathogenetic role in FSGS.

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Prediction and treatment of recurrent focal segmental glomerulosclerosis after renal transplantation in children

Cited by 188 publications

References 23 publications

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

Inhibition of renal permeability towards albumin: A new function of apolipoproteins with possible pathogenetic relevance in focal glomerulosclerosis

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