Department of Nephrology, Toho University School of Medicine, Tokyo, Japan.
Clin Transplant. 2010 Jul;24 Suppl 22:60-5. doi: 10.1111/j.1399-0012.2010.01279.x.
We discuss a renal transplant patient with focal segmental glomerulosclerosis (FSGS) treated with plasma exchange and rituximab. A 45-yr-old woman underwent cadaveric renal transplantation in May 2008. She had started hemodialysis support in 1991. Immediately after transplantation, massive proteinuria (1-5 g/d) appeared. Graft biopsy at one h showed minor glomerular abnormalities with partial foot process effacement on electric microscopy. Protocol biopsy at three months after transplantation for persistent proteinuria showed obvious FSGS under light microscopy. Plasma exchange and rituximab administration were subsequently initiated in August 2008, and proteinuria disappeared within a month after starting these treatments. Protocol graft biopsy one yr after transplantation (2009) showed increased global sclerosis and a decrease in segmental sclerosis. In addition, foot process effacement had recovered by one yr after transplantation. Plasma exchange and subsequent rituximab administration led to clinical remission of post-transplant FSGS with improvement in podocyte structure. Rituximab should be considered soon after several sessions of plasmapheresis in transplant patients with recurrent FSGS.
我们讨论了一位接受血浆置换和利妥昔单抗治疗的局灶节段性肾小球硬化症（FSGS）的肾移植患者。一名 45 岁女性于 2008 年 5 月接受尸体肾移植。她于 1991 年开始接受血液透析支持。移植后立即出现大量蛋白尿（1-5g/d）。移植后 1 小时的肾活检显示肾小球有轻微异常，电镜下部分足突消失。移植后 3 个月因持续性蛋白尿进行的方案活检显示明显的 FSGS。随后于 2008 年 8 月开始进行血浆置换和利妥昔单抗治疗，治疗后 1 个月内蛋白尿消失。移植后 1 年的方案活检（2009 年）显示全球硬化增加，节段性硬化减少。此外，移植后 1 年足突消失得到恢复。血浆置换和随后的利妥昔单抗治疗导致移植后 FSGS 临床缓解，足细胞结构改善。对于复发性 FSGS 的移植患者，在进行几次血浆置换后应考虑使用利妥昔单抗。
