Focal segmental glomerulosclerosis in one of two "en bloc" pediatric transplanted kidneys

Focal segmental glomerulosclerosis (FSGS) is thought to have several causes, including hypertension, reduction of nephron mass, or immunologic processes. Experimental studies have underlined the role of glomerular adaptation to capillary pressure in the growing kidney after partial nephrectomy. We report here the occurrence of FSGS in one of two "en bloc" pediatric kidneys transplanted in an adult recipient. One of the kidneys sustained early ureteral obstruction requiring reoperation and subsequently developed pathological changes on biopsy consistent with FSGS, whereas the mate kidney did not, although both kidneys grew at equal rates and to equivalent sizes.