Recurrence of Focal Segmental Glomerulosclerosis after Renal Transplantation: A Case Report

Focal segmental glomerulosclerosis (FSGS) may recur following transplantation. Approximately half of the patients with recurrent FSGS lose their grafts. We report a case of a 54-year-old woman with focal segmental glomerulosclerosis (FSGS). She underwent live-related donor kidney transplantation from her 21-year-old son and immunosuppression was maintained with tacrolimus, mycophenolate mofetil and steroids. Eight months after transplantation, the patient presented with increasing lower limbs edema and heavy proteinuria. Allograft biopsy contained 20 glomeruli of which four were totally sclerosed, seven were segmentally sclerotic, and the rest were non-sclerotic, relatively enlarged glomeruli compatible with recurrent FSGS in the graft. Plasmapheresis over a two week period with simultaneous oral cyclophosphamide resulted in a partial response of proteinuria from 12 to 2.2 g/24hrs over 5 weeks.