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BioMed Research International
Volume 2016, Article ID 3295618, 7 pages
http://dx.doi.org/10.1155/2016/3295618
Review Article

FSGS Recurrence in Adults after Renal Transplantation

Department of Internal Medicine IV-Nephrology and Hypertension, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

Received 25 December 2015; Accepted 27 March 2016

Academic Editor: Björn Meijers

Copyright © 2016 Michael Rudnicki. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recurrence of focal segmental glomerulosclerosis (FSGS) in the allograft occurs in 30–50% of patients, and it is associated with poor renal allograft survival. Major risk factors for recurrence are younger age at diagnosis, rapid progression to end-stage renal disease, white race, and the loss of previous allografts due to recurrence. Recent data support the hypothesis that circulating permeability factors play a crucial role in podocyte injury and progression of FSGS. Due to lack of controlled trials, the management of recurrent FSGS is inconsistent and highly empirical. Prophylactic and perioperative treatment with plasmapheresis and high-dose (intravenous) cyclosporine represent the main cornerstones of immunosuppressive therapy. In recent years, therapy with rituximab has shown promising results. Despite evidence of activation of the renin-angiotensin system (RAS) in recurrent FSGS and its association with progression, only limited data exist on the renoprotective role of RAS blockade in this setting. Further well designed studies are needed on pathogenesis risk factors and therapeutical options in FSGS and its recurrence after transplantation.