Plasmapheresis and dipyridamole for recurrent focal glomerular sclerosis

A 38-year-old man had recurrence of nephrotic syndrome with focal glomerular sclerosis (FGS) in two consecutive cadaveric renal allografts. His first graft was lost to recurrent disease after 30 months. Because prior animal experiments performed when he had his first graft indicated a possible serum factor or factors capable of enhancing urine protein excretion, three plasmapheresis periods of 6-8 treatments each were performed 3, 23 and 34 months after recurrence of FGS in the second graft. Urine protein excretion was decreased transiently in the first treatment period when the allograft biopsy revealed only glomerular foot process effacement. The second and third plasmapheresis treatment periods were performed after typical lesions of FGS were present in the graft and moderate renal insufficiency occurred. Dipyridamole was also given at this time. There has been associated stabilization of renal function for over 31 months. Prior to this, renal function was significantly (p less than 0.001) decreasing with time. The reasons for stabilization of renal function in this man with recurrent FGS are not defined, but the results suggest the need to further evaluate plasmapheresis and the platelet inhibitor dipyridamole in native and recurrent FGS.