How to treat recurrent focal segmental glomerulosclerosis after kidney transplantation in children

Focal segmental glomerulosclerosis (FSGS), a significant cause of kidney failure in children, is a common pathological diagnosis in cases of idiopathic nephrotic syndrome, especially steroid-resistant ones. FSGS has the potential to recur after kidney transplantation, often leading to graft loss. However, not all children with FSGS experience recurrence posttransplantation, such as those with genetic or secondary forms, which have minimal risk. Moreover, advancements in management, including intensive plasmapheresis and immunosuppressive therapies like rituximab, have increased remission rates in cases of recurrence. Identifying patients at high risk of recurrence, such as those with an initial treatment response or previous failed transplantation, is crucial. These children require close monitoring of proteinuria and prompt, intensive treatment upon recurrence to improve outcomes.