Pradhan Madhura, Petro Julie, Palmer Joanne, Meyers Kevin, Baluarte H Jorge
Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Pediatr Nephrol. 2003 Sep;18(9):934-8. doi: 10.1007/s00467-003-1208-z. Epub 2003 Jun 26.
Recurrence of focal segmental glomerulosclerosis (FSGS) in an allograft is a challenging clinical situation because it frequently results in graft loss. We report our experience with early use of plasmapheresis in recurrent FSGS. Of the 18 (33%) children with biopsy-proven FSGS (in their native kidneys) transplanted at our institution, 6 had recurrence (elevated urine protein/creatinine ratios) post transplant and were treated with plasmapheresis. Patients who received treatment within 1 day of the recurrence (4/6) went into remission after 5-13 plasmapheresis treatments, within 5-27 days of starting treatment. Patients who did not respond to plasmapheresis (2/6) were treated 7 and 17 days after onset of proteinuria; 1 of these had acute tubular necrosis and acute rejection leading to graft loss and the other developed acute rejections, ongoing proteinuria, and subsequent graft loss. All 4 patients who went into remission have maintained good graft function, 22-53 months post transplant. In our experience early institution of plasmapheresis for recurrent post-transplant proteinuria in FSGS is effective.
同种异体移植肾中局灶节段性肾小球硬化（FSGS）的复发是一种具有挑战性的临床情况，因为它常常导致移植肾丧失。我们报告了早期使用血浆置换治疗复发性FSGS的经验。在我们机构接受活检证实为FSGS（在其自身肾脏中）的18名儿童（占33%）接受了移植，其中6名在移植后出现复发（尿蛋白/肌酐比值升高）并接受了血浆置换治疗。在复发后1天内接受治疗的患者（4/6）在进行5 - 13次血浆置换治疗后，即在开始治疗后的5 - 27天内病情缓解。对血浆置换无反应的患者（2/6）在蛋白尿出现后7天和17天接受治疗；其中1例发生急性肾小管坏死和急性排斥反应导致移植肾丧失，另1例发生急性排斥反应、持续性蛋白尿及随后的移植肾丧失。所有4例病情缓解的患者在移植后22 - 53个月均维持了良好的移植肾功能。根据我们的经验，对于FSGS移植后复发性蛋白尿早期进行血浆置换是有效的。
