Complete remission of post-transplant FSGS recurrence by long-term plasmapheresis
Focal segmental glomerulosclerosis (FSGS) is known to recur in approximately 30% of renal allografts with graft loss in about half of these cases. The exact etiology remains unclear, though a putative circulating permeability factor or loss of inhibitory substances is being discussed. Different ther...
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| Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2005-07, Vol.20 (7), p.994-997 |
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| container_title | Pediatric nephrology (Berlin, West) |
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| creator | Häffner, Karsten Zimmerhackl, Lothar B von Schnakenburg, Christian Brandis, Matthias Pohl, Martin |
| description | Focal segmental glomerulosclerosis (FSGS) is known to recur in approximately 30% of renal allografts with graft loss in about half of these cases. The exact etiology remains unclear, though a putative circulating permeability factor or loss of inhibitory substances is being discussed. Different therapeutic approaches have been used. We report on a 10-year-old Arabian boy with a recurrence of FSGS immediately after transplantation. In addition to intensifying immunosuppressive therapy with high-dose cyclosporin A and cyclophosphamide, plasmapheresis was initiated and remission was achieved after 8 months. Three weeks after cessation of plasmapheresis a relapse occurred. Plasmapheresis was resumed and remission was achieved again after four additional sessions. The interval between plasmapheresis treatments was then gradually increased and fourteen months after transplantation plasmapheresis was stopped again. Since then (1.5 years after cessation of treatment) the patient has been in complete remission without any further episode of proteinuria. In conclusion, complete and sustained remission with stable renal function was achieved in our patient by long-term plasmapheresis in combination with intensified immunosuppression. Therefore, continuation of plasmapheresis treatment should be considered even in the situation of initial non-response. |
| doi_str_mv | 10.1007/s00467-005-1858-0 |
| format | Article |
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The exact etiology remains unclear, though a putative circulating permeability factor or loss of inhibitory substances is being discussed. Different therapeutic approaches have been used. We report on a 10-year-old Arabian boy with a recurrence of FSGS immediately after transplantation. In addition to intensifying immunosuppressive therapy with high-dose cyclosporin A and cyclophosphamide, plasmapheresis was initiated and remission was achieved after 8 months. Three weeks after cessation of plasmapheresis a relapse occurred. Plasmapheresis was resumed and remission was achieved again after four additional sessions. The interval between plasmapheresis treatments was then gradually increased and fourteen months after transplantation plasmapheresis was stopped again. Since then (1.5 years after cessation of treatment) the patient has been in complete remission without any further episode of proteinuria. In conclusion, complete and sustained remission with stable renal function was achieved in our patient by long-term plasmapheresis in combination with intensified immunosuppression. Therefore, continuation of plasmapheresis treatment should be considered even in the situation of initial non-response.</description><identifier>ISSN: 0931-041X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s00467-005-1858-0</identifier><identifier>PMID: 15889282</identifier><language>eng</language><publisher>Germany: Springer</publisher><subject>Administration, Oral ; Care and treatment ; Case studies ; Child ; Complications and side effects ; Cyclophosphamide - administration & dosage ; Cyclophosphamide - therapeutic use ; Cyclosporine - administration & dosage ; Cyclosporine - therapeutic use ; Dose-Response Relationship, Drug ; Glomerulonephritis ; Glomerulosclerosis, Focal Segmental - surgery ; Glomerulosclerosis, Focal Segmental - therapy ; Health aspects ; Humans ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - therapeutic use ; Injections, Intravenous ; Kidney Transplantation ; Kidneys ; Male ; Plasmapheresis ; Recurrence ; Remission Induction ; Severity of Illness Index ; Time Factors ; Transplantation</subject><ispartof>Pediatric nephrology (Berlin, West), 2005-07, Vol.20 (7), p.994-997</ispartof><rights>COPYRIGHT 2005 Springer</rights><rights>IPNA 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c357t-c448e430dda3d56668f744462e5a50376a560250180e42774ca67f76fcd647b13</citedby><cites>FETCH-LOGICAL-c357t-c448e430dda3d56668f744462e5a50376a560250180e42774ca67f76fcd647b13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15889282$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Häffner, Karsten</creatorcontrib><creatorcontrib>Zimmerhackl, Lothar B</creatorcontrib><creatorcontrib>von Schnakenburg, Christian</creatorcontrib><creatorcontrib>Brandis, Matthias</creatorcontrib><creatorcontrib>Pohl, Martin</creatorcontrib><title>Complete remission of post-transplant FSGS recurrence by long-term plasmapheresis</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><description>Focal segmental glomerulosclerosis (FSGS) is known to recur in approximately 30% of renal allografts with graft loss in about half of these cases. The exact etiology remains unclear, though a putative circulating permeability factor or loss of inhibitory substances is being discussed. Different therapeutic approaches have been used. We report on a 10-year-old Arabian boy with a recurrence of FSGS immediately after transplantation. In addition to intensifying immunosuppressive therapy with high-dose cyclosporin A and cyclophosphamide, plasmapheresis was initiated and remission was achieved after 8 months. Three weeks after cessation of plasmapheresis a relapse occurred. Plasmapheresis was resumed and remission was achieved again after four additional sessions. The interval between plasmapheresis treatments was then gradually increased and fourteen months after transplantation plasmapheresis was stopped again. Since then (1.5 years after cessation of treatment) the patient has been in complete remission without any further episode of proteinuria. In conclusion, complete and sustained remission with stable renal function was achieved in our patient by long-term plasmapheresis in combination with intensified immunosuppression. 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The exact etiology remains unclear, though a putative circulating permeability factor or loss of inhibitory substances is being discussed. Different therapeutic approaches have been used. We report on a 10-year-old Arabian boy with a recurrence of FSGS immediately after transplantation. In addition to intensifying immunosuppressive therapy with high-dose cyclosporin A and cyclophosphamide, plasmapheresis was initiated and remission was achieved after 8 months. Three weeks after cessation of plasmapheresis a relapse occurred. Plasmapheresis was resumed and remission was achieved again after four additional sessions. The interval between plasmapheresis treatments was then gradually increased and fourteen months after transplantation plasmapheresis was stopped again. Since then (1.5 years after cessation of treatment) the patient has been in complete remission without any further episode of proteinuria. In conclusion, complete and sustained remission with stable renal function was achieved in our patient by long-term plasmapheresis in combination with intensified immunosuppression. Therefore, continuation of plasmapheresis treatment should be considered even in the situation of initial non-response.</abstract><cop>Germany</cop><pub>Springer</pub><pmid>15889282</pmid><doi>10.1007/s00467-005-1858-0</doi><tpages>4</tpages></addata></record> |
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| subjects | Administration, Oral Care and treatment Case studies Child Complications and side effects Cyclophosphamide - administration & dosage Cyclophosphamide - therapeutic use Cyclosporine - administration & dosage Cyclosporine - therapeutic use Dose-Response Relationship, Drug Glomerulonephritis Glomerulosclerosis, Focal Segmental - surgery Glomerulosclerosis, Focal Segmental - therapy Health aspects Humans Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - therapeutic use Injections, Intravenous Kidney Transplantation Kidneys Male Plasmapheresis Recurrence Remission Induction Severity of Illness Index Time Factors Transplantation |
| title | Complete remission of post-transplant FSGS recurrence by long-term plasmapheresis |
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