Long-term plasmapheresis and protein A column treatment of recurrent FSGS

A. Belson, P. D. Yorgin, Amira Al-Uzri, O. Salvatierra, J. Higgins, S. R. Alexander

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Transient or intermittent plasmapheresis with concurrent immunosuppressive therapy is thought to be beneficial in the treatment of recurrent focal segmental glomerulosclerosis (FSGS) in the early post-transplant period. The results of long-term (6-year) plasmapheresis therapy, in a 9-year-old female with an immediate recurrence of FSGS [urinary protein/urinary creatinine (UP/UC)=17.7] after cadaveric renal transplant, are presented. A 4-week plasmapheresis course induced a decline in the proteinuria, but a relapse occurred after cessation of plasmapheresis. Addition of protein A column therapy led to a further decrease in the proteinuria, to a non-nephrotic range. Long-term control of the nephrotic syndrome was established using a chronic treatment regimen consisting of a single-volume plasmapheresis, followed by a protein A column treatment, performed on sequential days every 3-4 weeks. Mean UP/UC values decreased to 1.15±0.9. A course of cyclophosphamide was successfully used to control a worsening of proteinuria 4 years post transplant. Although sequential renal biopsies demonstrated progressive glomerular sclerosis, the patient's mean calculated creatinine clearance only modestly declined from 78.3 ml/min per 1.73 m2, at the time of transplantation, to 62.7 ml/min per 1.73 m2, 6 years later. This patient demonstrated dependence on plasmapheresis/protein A column therapy to maintain a clinical remission of her FSGS recurrence. While long-term plasmapheresis and protein A column therapy in combination with immunosuppressive therapy reversed the effects of uncontrolled nephrosis and possibly facilitated long-term renal allograft survival, the glomerular sclerosis continued to progress.

Original languageEnglish (US)
Pages (from-to)985-989
Number of pages5
JournalPediatric Nephrology
Volume16
Issue number12
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

Focal Segmental Glomerulosclerosis
Plasmapheresis
Staphylococcal Protein A
Proteinuria
Creatinine
Therapeutics
Sclerosis
Immunosuppressive Agents
Transplants
Kidney
Recurrence
Nephrosis
Nephrotic Syndrome
Cyclophosphamide
Allografts
Proteins
Transplantation
Biopsy

Keywords

  • Acute tubulointerstitial rejection
  • Creatinine clearance
  • Proteinuria
  • Renal biopsy

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Belson, A., Yorgin, P. D., Al-Uzri, A., Salvatierra, O., Higgins, J., & Alexander, S. R. (2001). Long-term plasmapheresis and protein A column treatment of recurrent FSGS. Pediatric Nephrology, 16(12), 985-989. https://doi.org/10.1007/s004670100008

Long-term plasmapheresis and protein A column treatment of recurrent FSGS. / Belson, A.; Yorgin, P. D.; Al-Uzri, Amira; Salvatierra, O.; Higgins, J.; Alexander, S. R.

In: Pediatric Nephrology, Vol. 16, No. 12, 2001, p. 985-989.

Research output: Contribution to journalArticle

Belson, A, Yorgin, PD, Al-Uzri, A, Salvatierra, O, Higgins, J & Alexander, SR 2001, 'Long-term plasmapheresis and protein A column treatment of recurrent FSGS', Pediatric Nephrology, vol. 16, no. 12, pp. 985-989. https://doi.org/10.1007/s004670100008
Belson, A. ; Yorgin, P. D. ; Al-Uzri, Amira ; Salvatierra, O. ; Higgins, J. ; Alexander, S. R. / Long-term plasmapheresis and protein A column treatment of recurrent FSGS. In: Pediatric Nephrology. 2001 ; Vol. 16, No. 12. pp. 985-989.
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