Recurrent focal glomerulosclerosis: Natural history and response to therapy

Renal Allograft Survival in Transplant Recipients with Focal Segmental Glomerulosclerosis

“…The pathogenesis of FSGS remains unclear but has been attributed to a 'circulating factor' present in the serum of patients with FSGS (2). Recurrence of FSGS after transplantation is not unusual and is most likely to occur in those recipients who have progressed rapidly to end-stage renal disease (ESRD) from the time of diagnosis (3). Post-transplantation recurrence of FSGS in the kidney allograft can occur in up to 50% of renal allografts (4).…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…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).…”

“…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).…”

“…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.…”

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

“…[2][3][4][5] Casos de remissão espontânea foram observados, porém, são raros. 6 A observação de que na maioria dos casos de recorrência a proteinúria aparece dentro de poucas horas do transplante, sugere a possibilidade de um fator circulante humoral responsável pelo aumento da permeabilidade da membrana basal glomerular, proteinúria e, eventualmente, GESF.…”