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Case Reports in Transplantation
Volume 2016, Article ID 7137584, 4 pages
Case Report

Successful Treatment of Focal Segmental Glomerulosclerosis after Kidney Transplantation with Plasma Exchange and Abatacept in a Patient with Juvenile Rheumatoid Arthritis

1Department of Nephrology and Dialysis, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
2Vorarlberg Institute for Vascular Investigation and Treatment, Academic Teaching Hospital Feldkirch, 6800 Feldkirch, Austria
3Clinical Pathology and Cytodiagnostics, 6060 Hall in Tirol, Austria

Received 22 January 2016; Revised 1 March 2016; Accepted 3 March 2016

Academic Editor: Ryszard Grenda

Copyright © 2016 Hannelore Sprenger-Mähr et al. 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.


Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation is difficult to treat. Recently a series of four patients unresponsive to plasma exchange (PE) and rituximab, who were successfully treated with abatacept, has been reported. We present a 26-year-old Caucasian patient who suffered from juvenile rheumatoid arthritis and developed severe proteinuria eleven days after transplantation. An allograft biopsy was suggestive of recurrent focal segmental glomerulosclerosis. He did not respond to PE therapy. A first dose of abatacept produced partial remission. Four weeks later proteinuria again increased and a second biopsy showed progression of disease. After another ineffective course of PE he was given a second dose of abatacept, which was followed by rapid, complete, and sustained resolution of proteinuria. This treatment caused a significant increase in BK and JC viremia. Whether abatacept ameliorated proteinuria via an effect on podocytes or on the patient’s primary disease remains speculative.