Recurrence of local segmental glomerulosclerosis in 2 patients with renal allograft and review
- VernacularTitle:移植肾复发性局灶、节段性肾小球硬化二例
- Author:
Junjie MA
;
Lixin YU
;
Guobao WANG
;
Al ET
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Glomerulosclerosis,focal;
Recurrence;
Transplants
- From:
Chinese Journal of Organ Transplantation
2003;0(01):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective Recurrence of local segmental glomerulosclerosis (FSGS) in 2 patients with renal allograft was reported.Methods A male child aged 15 years and a male adult aged 25 years with primary FSGS, who were subjected to cadaveric kidney transplantation, had a recurrent nephritic syndrome showing massive proteinuria, hyperlipidemia and hypertension respectively in 2 weeks and 18 months postoperatively, that was suspected a recurrent FSGS. The child immediately was treated with Benazepril hydrochloride, 30?mg /day plus high dosage of Prednisolone ( 1?mg /kg every day) for 6 weeks, but proteinuria did not to be ameliorated. The adult was treated with high dosage of Prednisolone ( 1?mg /kg every) and Tripterygium wifordii for 12 weeks, but the syndrome was not improved. Results Two patients had recurrent FSGS according to renal biopsy revealing characterized by similar features: diffuse effacement of foot processes on electron microscope, segmental or focal sclerosis under light microscope and IgM, IgG, C3 deposits. The therapy of plasmapheresis as well as high dosage of Benazepril hydrochloride was added to institute respectively for continuous 3 sessions with removal of 1.5 volume plasma ( 1 200?ml of plasma) in the child and successive 6 sessions with removal of same volume ( 3 000?ml of plasma). The child's proteinuria had a significant reduction from 8.29?g /day to 4.52?g /day after a week post pheresis, that kept 4.52 ～ 5.56 ?g/day with stable creatitine (180～200??mol/L) following 18 months. The adult's proteinaria obvious decreased from 4.68?g /day to 1.50?g /day after plasma exchange a week and keeping decline to 1.06?g /day with normal renal function following 12 months. Conclusion FSGS may immediately be recurrence in pediatric renal transplants. The mechanism of recurrent FSGS may be associated with excessive glomerular filtration, circulating factor altering glomerular permeability, injection of anti thymocyte and lymphocyte immunoglobulin, and hyperlipidemia. Plasmapheresis in combined with ACE inhibitor can reduce proteinuria significantly rather than a single ACE inhibitor.
