Sa Rula, Guo Zhiliang, Zhao Guangyuan, Zhao Daqiang, Guo Hui, Chen Gang, Zhu Lan
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; NHC Key Laboratory of Organ Transplantation, Ministry of Education, Chinese Academy of Medical Sciences, Wuhan, China.
Transplant Proc. 2023 Apr;55(3):649-653. doi: 10.1016/j.transproceed.2022.12.016. Epub 2023 Mar 21.
Focal segmental glomerular sclerosis (FSGS) tends to recur after kidney transplantation, particularly when genetic testing is negative. Once the recurrence happens, the renal graft function can rapidly become impaired, following a massive urine protein loss. Despite intensive plasmapheresis and high-dose rituximab treatment, the complete remission rate remains below 50%. The Kunxian capsule, representing a new generation of tripterygium preparation, has shown promising results in controlling proteinuria in patients with IgA nephropathy. It is unclear whether Kunxian capsule treatment would also produce a favorable response in cases of FSGS recurrence. Here we report favorable results with this approach in a patient with early recurrent FSGS after kidney transplantation; we treated this patient successfully with a Kunxian capsule, a low dose of rituximab (200 mg), and reduced sessions of plasmapheresis. Complete remission, with a 90% reduction in total urine protein (0.81 g/24 h vs 8.3 g/24 h), was achieved within 2 weeks post-treatment. Of interest, the complete remission state in this patient has been maintained over 20 months with continuous administration of Kunxian capsules after the cessation of plasmapheresis. The potential mechanisms involved here include direct podocyte protection and the anti-inflammatory and immunosuppressive properties of triptolide in the Kunxian capsule. Our case may offer a new reference option for treating recurrent FSGS in the future.
局灶节段性肾小球硬化（FSGS）在肾移植后易于复发，尤其是基因检测呈阴性时。一旦复发，肾移植功能会迅速受损，并伴有大量尿蛋白丢失。尽管进行了强化血浆置换和高剂量利妥昔单抗治疗，完全缓解率仍低于50%。昆仙胶囊作为新一代雷公藤制剂，在控制IgA肾病患者蛋白尿方面已显示出有前景的结果。目前尚不清楚昆仙胶囊治疗在FSGS复发病例中是否也会产生良好反应。在此，我们报告了一名肾移植后早期复发性FSGS患者采用这种方法取得的良好结果；我们用昆仙胶囊、低剂量利妥昔单抗（200mg）和减少血浆置换次数成功治疗了该患者。治疗后2周内实现了完全缓解，总尿蛋白减少90%（从8.3g/24小时降至0.81g/24小时）。有趣的是，在停止血浆置换后持续服用昆仙胶囊，该患者的完全缓解状态已维持超过20个月。其中涉及的潜在机制包括对足细胞的直接保护以及昆仙胶囊中雷公藤甲素的抗炎和免疫抑制特性。我们的病例可能为未来治疗复发性FSGS提供一种新的参考选择。
