Focal Segmental Glomerulosclerosis Management in Kidney Transplantation
Summary
Focal segmental glomerulosclerosis (FSGS) is a podocytopathy characterised by segmental scarring of glomeruli and heavy proteinuria, and it represents a significant challenge in kidney transplantation owing to recurrence in approximately 30–50% of recipients. Recurrence is often driven by a circulating permeability factor that injures donor podocytes and precipitates nephrotic syndrome in the allograft. Risk factors include younger age at disease onset, rapid progression to end-stage renal disease, prior recurrence in a previous graft, and certain immunogenetic profiles. Management strategies encompass peri-operative plasmapheresis aimed at removing putative circulating factors, optimisation of conventional immunosuppression, and the use of B-cell–depleting agents such as rituximab. Recent work has also explored genetic and molecular predictors of recurrence, enabling more precise patient stratification. Despite advances, graft loss due to recurrent FSGS remains a major cause of morbidity, and ongoing research seeks to refine prophylactic and therapeutic approaches to improve long-term graft survival and quality of life.
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Focal Segmental Glomerulosclerosis Management in Kidney Transplantation publication trend
The graph below shows the total number of articles in focal segmental glomerulosclerosis management in kidney transplantation across all publications each year (not limited to Nature Index journals).
Technical terms
Focal segmental glomerulosclerosis (FSGS): A disease of the kidney’s filtering units characterised by scarring of some glomeruli segments, leading to proteinuria and nephrotic syndrome.
Podocyte: A specialised epithelial cell wrapping glomerular capillaries that contributes to the filtration barrier; damage to podocytes is central to FSGS pathogenesis.
Circulating permeability factor: A yet-unidentified plasma molecule thought to increase glomerular permeability and trigger podocyte injury in primary and recurrent FSGS.
Plasmapheresis: A procedure that filters plasma to remove pathogenic factors, regularly used to treat recurrent FSGS in transplant recipients.
Rituximab: A monoclonal antibody targeting CD20 on B cells, employed to deplete B cells and reduce production of pathogenic factors implicated in FSGS recurrence.
References
- The role of HLA antigens in recurrent primary focal segmental glomerulosclerosis. Frontiers in Immunology (2023).
- Prophylactic treatment of FSGS recurrence in patients who relapsed on a previous kidney graft. Nephrology Dialysis Transplantation (2024).
- Identification of Pathogenic Pathways for Recurrence of Focal Segmental Glomerulosclerosis after Kidney Transplantation. Diagnostics (2024).
- A retrospective study of focal segmental glomerulosclerosis: clinical criteria can identify patients at high risk for recurrent disease after first renal transplantation. BMC Nephrology (2013).
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