Successful renal transplantation in focal glomerular sclerosis: report of two cases

The fate of renal allografts has provided much useful information about the pathogenesis of certain glomerular diseases. Idiopathic nephrotic syndrome with focal glomerular sclerosis (FGS) has been reported to recur in transplants. Two patients are reported with idiopathic nephrotic syndrome who progressed to renal failure. Immunopathologic and ultrastructural studies appeared to exclude immune pathogenic mechanisms in both patients, and light microscopic findings were characteristics of FGS. The nephrotic syndrome in one patient was initially steroid-dependent. Both patients underwent bilateral nephrectomy prior to renal transplantation. Graft function and urine protein excretion were normal in both patients 2 and 4 years respectively after transplantation, and transplant biopsies revealed no evidence of recurrent FGS. These results indicate that renal transplantation in patients with idiopathic nephrotic syndrome and FGS is not invariably followed by recurrent glomerular disease and suggest that the responsible pathogenetic mechanism(s) may not always persist.