Recurrence of focal segmental glomerulosclerosis in the transplanted kidney

The clinical and renal biopsy findings in 3 patients with recurrent focal and segmental glomerulosclerosis (FSG) are reported, as well as the results of a survey among 17 European centers totaling 27 kidney-transplanted children with FSG. From these 27 patients, 10 had recurrent FSG. The duration of the original disease was less than 3 years in 9 of them. In contrast, this rapid progression of the disease was observed in only 7 of 17 patients in the group without recurrences. Heavy proteinuria was noted within the 1st day, or week, in all but 2 patients where it was detected at 3 and 7 weeks. All developed the nephrotic syndrome. From the 10 kidneys (mostly from cadaver donors) which functioned for more than 1 month, 5 were lost 2--24 months after transplantation because of recurrence (3 patients) or infection (2 patients). It appears that the risk of recurrence can best be predicted by the duration of the original disease: 50% or more if the duration was short (less than 3 years), and only 10--20% when the duration was longer.