Recurrent FSGS Treatment Options

Objective: The clinical and pathological features and prognosis of recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation and autologous kidney FSGS. Methods: The clinical diagnosis of three cases of recurrent clinical manifestations of FSGS, pathological features and outcome of retrospective analysis of autologous kidney for kidney and transplant kidney renal biopsy results.
Results:
(1) autologous renal clinical features of FSGS:
Three cases of patients with age at onset of FSGS kidney were 17 years old (male), 23-year-old (female), aged 40 (female), the time of biopsy, urinary protein excretion were 7.55g/24h, 10.45g/24h 14.26g/24h, serum creatinine, respectively 99.0μmol / L 105.2μmol / L, 265.2μmol / L,. The course of progression to ESRD were 4 years, 2 years, 4 years.
(2) autologous renal pathological features of FSGS: the proportion of three cases of patients with ball / segmental sclerosis were 5.3% / 42.1%, 0/6.9%, 40% / 33.3%, renal tubular interstitial acute / chronic lesions were 0/10%, 10% / 0,10% / 30%. Cases 2 and Example 3 foot process fusion extensive (> 50%) (cases 1, specimens from electron microscopy organizations). Example 1 and Example 3, the cell type, the top of the type in Example 2.
(3) the clinical features of recurrent FSGS: Example 1 and Example 2 after transplantation 10d, 40d appear proteinuria (respectively for 18.27g/24h to the 7.55g/24h), Case 3 is unknown; and transplantation After 130d, 67d, 70d by renal biopsy diagnosed as FSGS, urinary protein excretion in the biopsy were: 10.13g/24h, 15.8g/24h, 4.38g/24h, serum creatinine the for 114.0μmol / L, 484. 4μmol / L, 701.8μmol / L.
(4) the recurrent Qian Gs and pathological features of the sub-type: early showed only for the foot suddenly wide range of fusion, segmental sclerosis, segmental sclerosis repeat biopsy, and accompanied by significant tubular interstitial acute lesions; Example 1 and Example 3 cell transplant relapse remains after the cell type, the top of the type in Example 2, the recurrence of collapse type.
(5) recurrence of FSGS outcome: Example 1 plasma exchange, proteinuria partial remission, serum creatinine increased slowly, for example, two lines of immunoadsorption treatment, results are poor, the loss of graft function at 3 months, cases of three missing follow-up . Conclusion: Recurrent FSGS clinical proteinuria, and accompanied by renal insufficiency, the pathophysiological mechanisms may be associated with autologous kidney disease; early proteinuria of FSGS patients after transplantation, it is timely transplant. Renal biopsy, under the light microscope without glomerular segmental sclerosis, but AMD results show the wide range of integration for the foot process, and repeat renal biopsy, glomerular segmental sclerosis; of FSGS recurrence after pathological type with autologous the same kidney may also occur in the transition.