Keith Douglas Scott
Department of Medicine, University of Virginia Medical Center, Charlottesville, Virginia 22908-0133, USA.
Semin Dial. 2012 Mar-Apr;25(2):190-2. doi: 10.1111/j.1525-139X.2011.01031.x. Epub 2011 Dec 16.
Recurrent idiopathic focal segmental glomerulosclerosis (FSGS) after renal transplantation can lead to a rapid failure of the allograft. A circulating, nonimmunoglobulin factor appears to be important in the pathogenesis of this complication in many cases. Between 30% and 50% of transplant recipients with FSGS develop recurrent disease. Three major risk factors for recurrence have been identified: short duration of native kidney disease, history of recurrence with previous kidney transplant, and pediatric aged recipients. Although no properly controlled trials have been conducted, plasmapheresis has emerged as one of the important treatment modalities for this entity. Retrospective studies prior to the routine use of plasmapheresis showed graft loss rates as high as 80%, a rate much higher than that seen in more recent series managed with plasmapheresis. Duration and intensity of treatment of plasmaphersis have not been studied rigorously, but in most case series, plasmapheresis was continued until a clear diminution of proteinuria was seen. The benefit of other adjuvant therapies for this condition remains unclear, but also may play a role in the treatment of this entity.
肾移植后复发性特发性局灶节段性肾小球硬化（FSGS）可导致移植肾迅速失功。在许多病例中，一种循环的非免疫球蛋白因子似乎在这种并发症的发病机制中起重要作用。30%至50%的FSGS移植受者会发生疾病复发。已确定复发的三个主要危险因素：原肾疾病病程短、既往肾移植有复发史以及儿童受者。尽管尚未进行适当的对照试验，但血浆置换已成为治疗该疾病的重要方法之一。在常规使用血浆置换之前的回顾性研究显示移植肾丢失率高达80%，这一比率远高于最近采用血浆置换治疗的系列研究中的比率。血浆置换的治疗持续时间和强度尚未得到严格研究，但在大多数病例系列中，血浆置换会持续进行，直到蛋白尿明显减少。其他辅助治疗对这种疾病的益处仍不明确，但也可能在该疾病的治疗中发挥作用。
