Therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis following transplantation

Sherry Shariatmadar, T. A. Noto

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Focal segmental glomerulosclerosis (FSGS) recurs in 30% of renal allograft transplants with graft loss in half of the cases. A humoral factor may be implicated. We report on the use of therapeutic plasma exchange (TPE) in 11 patients with recurrent FSGS post transplantation. Medical records from 1989-2000 were reviewed for 11 adults transplanted for biopsy proven FSGS. Ten patients developed proteinuria (x: 6.1 g; range: 3-40 g/24 h) within 2 months of transplantation. In 1 patient, proteinuria (4 g) occurred 2 years post transplantation. Biopsy in six patients revealed early recurrent FSGS, while in five, suspected recurrence was based on clinical findings. Each patient received 5-11 TPEs (x: 6) with the COBE Spectra, daily or on alternate days with 2.5-3.5 L 5% albumin as the replacement fluid. In four, FFP was included because of coagulopathy. All received immunosuppression (IS) during and after TPE. A persistent drop in 24 h urine protein (U.P.) was observed in 10/11 patients. Seven had > 70% drop in 24 h U.P. following the course of TPE, while three had a reduction of 45-50%. No change occurred in 1 patient. Follow-up (9 months-5 years) of seven patients has shown a persistent U.P. of < 1 g with successful allograft survival. In these patients, TPE appeared effective in early recurrent FSGS. The decrease in U.P. may result from combined TPE and IS. Although the disease is designated in category III by the ASFA, TPE should be considered early when FSGS recurrence is established.

Original languageEnglish
Pages (from-to)78-83
Number of pages6
JournalJournal of Clinical Apheresis
Volume17
Issue number2
DOIs
StatePublished - Aug 5 2002

Fingerprint

Focal Segmental Glomerulosclerosis
Plasma Exchange
Transplantation
Urine
Therapeutics
Proteinuria
Immunosuppression
Allografts
Proteins
Transplants
Biopsy
Recurrence
Therapeutic Uses
Medical Records
Albumins
Kidney

Keywords

  • Circulating factor
  • Focal segmental glomerulosclerosis
  • Nephrotic syndrome
  • Proteinuria
  • Recurrence
  • Transplantation

ASJC Scopus subject areas

  • Hematology

Cite this

Therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis following transplantation. / Shariatmadar, Sherry; Noto, T. A.

In: Journal of Clinical Apheresis, Vol. 17, No. 2, 05.08.2002, p. 78-83.

Research output: Contribution to journalArticle

@article{1fc69ac88612491a86bc201fd3395b4c,
title = "Therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis following transplantation",
abstract = "Focal segmental glomerulosclerosis (FSGS) recurs in 30{\%} of renal allograft transplants with graft loss in half of the cases. A humoral factor may be implicated. We report on the use of therapeutic plasma exchange (TPE) in 11 patients with recurrent FSGS post transplantation. Medical records from 1989-2000 were reviewed for 11 adults transplanted for biopsy proven FSGS. Ten patients developed proteinuria (x: 6.1 g; range: 3-40 g/24 h) within 2 months of transplantation. In 1 patient, proteinuria (4 g) occurred 2 years post transplantation. Biopsy in six patients revealed early recurrent FSGS, while in five, suspected recurrence was based on clinical findings. Each patient received 5-11 TPEs (x: 6) with the COBE Spectra, daily or on alternate days with 2.5-3.5 L 5{\%} albumin as the replacement fluid. In four, FFP was included because of coagulopathy. All received immunosuppression (IS) during and after TPE. A persistent drop in 24 h urine protein (U.P.) was observed in 10/11 patients. Seven had > 70{\%} drop in 24 h U.P. following the course of TPE, while three had a reduction of 45-50{\%}. No change occurred in 1 patient. Follow-up (9 months-5 years) of seven patients has shown a persistent U.P. of < 1 g with successful allograft survival. In these patients, TPE appeared effective in early recurrent FSGS. The decrease in U.P. may result from combined TPE and IS. Although the disease is designated in category III by the ASFA, TPE should be considered early when FSGS recurrence is established.",
keywords = "Circulating factor, Focal segmental glomerulosclerosis, Nephrotic syndrome, Proteinuria, Recurrence, Transplantation",
author = "Sherry Shariatmadar and Noto, {T. A.}",
year = "2002",
month = "8",
day = "5",
doi = "10.1002/jca.10025",
language = "English",
volume = "17",
pages = "78--83",
journal = "Journal of Clinical Apheresis",
issn = "0733-2459",
publisher = "Wiley-Liss Inc.",
number = "2",

}

TY - JOUR

T1 - Therapeutic plasma exchange in recurrent focal segmental glomerulosclerosis following transplantation

AU - Shariatmadar, Sherry

AU - Noto, T. A.

PY - 2002/8/5

Y1 - 2002/8/5

N2 - Focal segmental glomerulosclerosis (FSGS) recurs in 30% of renal allograft transplants with graft loss in half of the cases. A humoral factor may be implicated. We report on the use of therapeutic plasma exchange (TPE) in 11 patients with recurrent FSGS post transplantation. Medical records from 1989-2000 were reviewed for 11 adults transplanted for biopsy proven FSGS. Ten patients developed proteinuria (x: 6.1 g; range: 3-40 g/24 h) within 2 months of transplantation. In 1 patient, proteinuria (4 g) occurred 2 years post transplantation. Biopsy in six patients revealed early recurrent FSGS, while in five, suspected recurrence was based on clinical findings. Each patient received 5-11 TPEs (x: 6) with the COBE Spectra, daily or on alternate days with 2.5-3.5 L 5% albumin as the replacement fluid. In four, FFP was included because of coagulopathy. All received immunosuppression (IS) during and after TPE. A persistent drop in 24 h urine protein (U.P.) was observed in 10/11 patients. Seven had > 70% drop in 24 h U.P. following the course of TPE, while three had a reduction of 45-50%. No change occurred in 1 patient. Follow-up (9 months-5 years) of seven patients has shown a persistent U.P. of < 1 g with successful allograft survival. In these patients, TPE appeared effective in early recurrent FSGS. The decrease in U.P. may result from combined TPE and IS. Although the disease is designated in category III by the ASFA, TPE should be considered early when FSGS recurrence is established.

AB - Focal segmental glomerulosclerosis (FSGS) recurs in 30% of renal allograft transplants with graft loss in half of the cases. A humoral factor may be implicated. We report on the use of therapeutic plasma exchange (TPE) in 11 patients with recurrent FSGS post transplantation. Medical records from 1989-2000 were reviewed for 11 adults transplanted for biopsy proven FSGS. Ten patients developed proteinuria (x: 6.1 g; range: 3-40 g/24 h) within 2 months of transplantation. In 1 patient, proteinuria (4 g) occurred 2 years post transplantation. Biopsy in six patients revealed early recurrent FSGS, while in five, suspected recurrence was based on clinical findings. Each patient received 5-11 TPEs (x: 6) with the COBE Spectra, daily or on alternate days with 2.5-3.5 L 5% albumin as the replacement fluid. In four, FFP was included because of coagulopathy. All received immunosuppression (IS) during and after TPE. A persistent drop in 24 h urine protein (U.P.) was observed in 10/11 patients. Seven had > 70% drop in 24 h U.P. following the course of TPE, while three had a reduction of 45-50%. No change occurred in 1 patient. Follow-up (9 months-5 years) of seven patients has shown a persistent U.P. of < 1 g with successful allograft survival. In these patients, TPE appeared effective in early recurrent FSGS. The decrease in U.P. may result from combined TPE and IS. Although the disease is designated in category III by the ASFA, TPE should be considered early when FSGS recurrence is established.

KW - Circulating factor

KW - Focal segmental glomerulosclerosis

KW - Nephrotic syndrome

KW - Proteinuria

KW - Recurrence

KW - Transplantation

UR - http://www.scopus.com/inward/record.url?scp=0036325119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036325119&partnerID=8YFLogxK

U2 - 10.1002/jca.10025

DO - 10.1002/jca.10025

M3 - Article

VL - 17

SP - 78

EP - 83

JO - Journal of Clinical Apheresis

JF - Journal of Clinical Apheresis

SN - 0733-2459

IS - 2

ER -