Recurrent disease in renal transplants

Newstead, Chas

doi:10.1093/ndt/gfg1068

Cited by 54 publications

(42 citation statements)

References 52 publications

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“…Genetic forms have been associated with NPHS2 mutations and the locus on chromosome 19q13 (29). Patients with idiopathic forms of diffuse mesangial hypercellularity are at increased risk for recurrent nephrotic syndrome after renal transplantation, which makes the clinical recognition of the disorder important (81).…”

Section: Diffuse Mesangial Hypercellularitymentioning

confidence: 99%

A Proposed Taxonomy for the Podocytopathies

Barisoni¹,

Schnaper²,

Kopp³

2007

Clinical Journal of the American Society of Nephrology

230

205

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A spectrum of proteinuric glomerular diseases results from podocyte abnormalities. The understanding of these podocytopathies has greatly expanded in recent years, particularly with the discovery of more than a dozen genetic mutations that are associated with loss of podocyte functional integrity. It is apparent that classification of the podocytopathies on the basis of morphology alone is inadequate to capture fully the complexity of these disorders. Herein is proposed a taxonomy for the podocytopathies that classifies along two dimensions: Histopathology, including podocyte phenotype and glomerular morphology (minimal-change nephropathy, focal segmental glomerulosclerosis, diffuse mesangial sclerosis, and collapsing glomerulopathy), and etiology (idiopathic, genetic, and reactive forms). A more complete understanding of the similarities and differences among podocyte diseases will help the renal pathologist and the nephrologist communicate more effectively about the diagnosis; this in turn will help the nephrologist provide more accurate prognostic information and select the optimal therapy for these often problematic diseases. It is proposed that final diagnosis of the podocytopathies should result from close collaboration between renal pathologists and nephrologists and should whenever possible include three elements: Morphologic entity, etiologic form, and specific pathogenic mechanism or association.Clin J Am Soc Nephrol 2: 529-542, 2007. doi: 10.2215/CJN.04121206 T he spectrum of primary nephrotic syndrome includes a variety of causes, presentations, histopathologic findings, and outcomes. These disorders may appear at any age, may be exquisitely sensitive or highly resistant to therapy, and have varied implications for long-term renal function. Past efforts to develop an organized approach to these diseases have largely centered on histopathology. Although these approaches were helpful in defining lesions, for each morphologic entity there is a wide range in response to treatment and outcome. This observation suggests that traditional pathologic description alone is insufficient to classify these disorders.Here, we propose a new taxonomy for podocyte diseases. The word "taxonomy" was coined by Carl Linnaeus, the 18th century Swedish scientist who proposed the system for naming and classifying organisms that remains in use today. A taxonomy is organized into multiple levels, each of which represents a taxon with one or more elements. The ideal taxonomy separates the elements of each taxon (the taxa) into mutually exclusive, unambiguous, and all-encompassing categories. In practice, a good taxonomy should be simple, easy to remember, and easy to use. Taxonomies provide classification and frequently more: A conceptual framework for analysis, discussion, and hypothesis generation. Our proposed podocyte taxonomy has two dimensions-histopathology and etiology-and includes additional modifiers related to biomarkers that have been identified through recent progress in the genetics, cell biology, and pathophysiol...

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Section: Diffuse Mesangial Hypercellularitymentioning

confidence: 99%

A Proposed Taxonomy for the Podocytopathies

Barisoni¹,

Schnaper²,

Kopp³

2007

Clinical Journal of the American Society of Nephrology

230

205

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“…Most recently, rituximab, a genetically engineered, chimeric, immunoglobulin G1 monoclonal antibody directed against CD20, was shown to be effective in reducing proteinuria in two pediatric patients with recurrence of FSGS and post-transplant lymphoproliferative disease (PTLD) (9,(41)(42)(43).…”

Section: Türk Nefroloji Diyaliz Ve Transplantasyon Dergisi Turkish Nementioning

confidence: 99%

“…Hoyer et al were the first authors to point out to this problem in 1972 (8). Afterwards the recurrence rate was reported to be about 30% for transplanted FSGS patients (9,10). Reported recurrence rate has a wide ratio between 20 to 80% of patients.…”

Section: Introductionmentioning

confidence: 99%

An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis

Emre¹,

Kazancıoğlu²,

Doğan³

et al. 2015

Turk Neph Dial Transpl

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OBJecTIve: Focal segmental glomerulosclerosis (FSGS) as a primary glomerular disease are refractory to therapy and progress to End stage renal disease. (ESRD). After transplantation, the major problems are recurrence of the disease and its treatment. In this study, We investigated FSGS recurrence. MATeRIAl and MeTHODS:The graft and patient's survivals, complications, recurrence rates, and therapeutic approach were documented. Twenty patients with FSGS and 20 patients as controls were included in the study. ReSulTS:The recurrence rate was significantly higher in FSGS group than controls (55 % vs 0 %, p<0.0001). We found that living and cadaveric donor transplantation have similar survival rate in FSGS. One of the most effecting factors on graft survival was genetic similarities between recipient and donor. Pre transplant plasmapheresis was found as effective treatment way for the prevention of FSGS recurrence. While proteinuria recurrence was 38% in the preemptive plasmapheresis group, it was 85% in the other patients with FSGS (p<0.05). cOncluSIOn:The importance of genetic similarities, similar results for graft survival in both living and cadaveric donor transplantation, and plasmapheresis as an effective approach for recurrent disease were the most important findings in this study. It also seems that the most effective therapeutic approach for the prevention of recurrence is pretransplant preemptive plasmapheresis. BulGulAR: Nüks oranı, FSGS li grupta, FSGS dışı gruba göre anlamlı olarak yüksek bulundu. (%55'e karşın %0, p= 0,0001). FSGS li hastalarda canlı ve kadavra nakillerinde, sürvi oranlarını birbirine benzer bulduk. Greft sürvisini en çok etkileyen faktörlerden birinin, alıcı ve verici arasındaki genetik benzerlik olduğunu saptadık. Transplantasyon öncesi plasmaferez tedavisinin, FSGS nüksünü önlemek açısından etkin bir tedavi olduğunu tesbit ettik. Transplantasyon öncesi plasmaferez uygulanan grupta proteinüri oranı % 38 olarak saptanırken, plasmaferez uygulanmayan grupta bu oran %85 olarak bulundu. (p= 0,05).SOnuÇ: Sonuç olarak bizim bu çalışmadaki en önemli çıkarımlarımız; genetik yakınlığın önemli olması, canlı ve kadavra nakillerinde greft sürvilerinin benzer bulunması, nüks hastalığının tedavisinde plasmaferezin etkin bir tedavi yöntemi olarak saptanmış olmasıdır. Ayrıca, daha da önemlisi, nüks hastalığının önlenmesinde, pre emptif plasmaferezi, en etkin tedavi yaklaşımı olarak saptadık.

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“…The benefits of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) in native kidney disease-mediated proteinuria have not been demonstrated as extensively in the transplant population, yet these agents have important antiproteinuric effects that can improve allograft survival in individuals with significant proteinuria (73). Cytotoxic medications such as cyclophosphamide may have limited benefits for specific posttransplantation entities, e.g., MPGN (74), recurrent anti-glomerular basement membrane glomerulonephritis (75), and focal and segmental glomerulosclerosis (76), but their use has to be gauged carefully and other antiproliferative immunosuppressive drug dosages may have to be altered to decrease untoward effects. When graft loss ensues, retransplantation remains an option.…”

Section: Chronic Allograft Dysfunctionmentioning

confidence: 99%

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

Djamali

Samaniego²,

Muth³

et al. 2006

Clinical Journal of the American Society of Nephrology

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Kidney transplantation is the treatment of choice for patients with ESRD. Despite improvements in short-term patient and graft outcomes, there has been no major improvement in long-term outcomes. The use of kidney allografts from expandedcriteria donors, polyoma virus nephropathy, underimmunosuppression, and incomplete functional recovery after rejection episodes may play a role in the lack of improvement in long-term outcomes. Other factors, including cardiovascular disease, infections, and malignancies, also shorten patient survival and therefore reduce the functional life of an allograft. There is a need for interventions that improve long-term outcomes in kidney transplant recipients. These patients are a unique subset of patients with chronic kidney disease. Therefore, interventions need to address disease progression, comorbid conditions, and patient mortality through a multifaceted approach. The Kidney Disease Outcomes Quality Initiative from the National Kidney Foundation, the European Best Practice Guidelines, and the forthcoming Kidney Disease: Improving Global Outcomes clinical practice guidelines can serve as a cornerstone of this approach. The unique aspects of chronic kidney disease in the transplant recipient require the integration of specific transplant-oriented problems into this care schema and a concrete partnership among transplant centers, community nephrologists, and primary care physicians. This article reviews the contemporary aspects of care for these patients.

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Recurrent disease in renal transplants

Cited by 54 publications

References 52 publications

A Proposed Taxonomy for the Podocytopathies

A Proposed Taxonomy for the Podocytopathies

An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

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Recurrent disease in renal transplants

Cited by 54 publications

References 52 publications

A Proposed Taxonomy for the Podocytopathies

A Proposed Taxonomy for the Podocytopathies

An Important Problem: Posttransplant Focal Segmental ￼Glomerulosclerosis Recurrence and Plasmapheresis

Medical Care of Kidney Transplant Recipients after the First Posttransplant Year

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An Important Problem: Posttransplant Focal Segmental Glomerulosclerosis Recurrence and Plasmapheresis