Therapeutic approach to focal and segmental glomerulosclerosis recurrence in kidney transplant recipients

Area of Science:

• Nephrology
• Transplantation Immunology

Background:

• Primary focal segmental glomerulosclerosis (FSGS) frequently leads to end-stage renal disease.
• FSGS recurrence post-kidney transplantation occurs in 20%-40% of cases, significantly reducing graft survival.
• The exact pathophysiology of primary FSGS is unknown, but a circulating factor causing glomerular hyperpermeability is suspected.

Purpose of the Study:

• To review the therapeutic strategies for focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation.
• To discuss the current understanding of FSGS pathophysiology and its implications for treatment.
• To highlight recent advances and potential targeted therapies for FSGS recurrence.

Main Methods:

• Literature review of studies on FSGS recurrence and its management.
• Analysis of treatment outcomes for plasma exchange, immunoadsorption, steroids, and cyclosporine.
• Synthesis of recent findings on FSGS pathogenesis and podocyte biology.

Main Results:

• Plasma exchange and protein immunoadsorption can temporarily reduce proteinuria but often fail to achieve sustained remission.
• Steroids and high-dose cyclosporine may reduce proteinuria via immunosuppression and podocyte stabilization.
• Current therapeutic approaches for FSGS recurrence show variable efficacy and are often based on limited evidence.

Conclusions:

• Effective and sustained treatment for FSGS recurrence remains a significant clinical challenge.
• Advances in understanding FSGS and podocyte function are paving the way for more targeted and potentially effective therapies.
• Further research is needed to establish optimal treatment protocols for FSGS recurrence to improve long-term graft survival.