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Outcome Of Primary Glomerular Disease In Pediatric Renal Transplantation: A Single-Center Experience

September 10, 2017

UroToday - A study done in Ankara, Turkey reported a single center experience to assess the frequency of the recurrence of primary glomerulonephritis in children after renal transplantation. They evaluated the charts of 14 children who had primary glomerular disease. Of these 14 children, 10 underwent a living related kidney transplant and the other 4 had cadaveric donors. 10 of these patients were diagnosed with focal segmental glomerulosclerosis, 2 had membranoproliferative glomerulonephritis and the remaining 2 polyarteritis nodosa. All of the diagnoses were biopsy proven in every case. All of the patients had calcineurin-based immunosuppressive therapy. The mean patient age was 15.5 years with a range of 11.1 to 20.9 years. The median transplant graft duration was 47 months.

They did have one patient who had a diagnosis of focal segmental glomerulosclerosis that had a hyper-acute rejection. That same patient received a second graft five years later and at seven years follow-up had a normal creatinine. The group also found that the rate of post transplant recurrence of focal segmental glomerulosclerosis was confirmed in two patients who were treated with plasmapheresis with no improvement of proteinuria and two patients with focal segmental glomerulosclerosis had thromboses after transplantation. All the other patients had functioning grafts. The group also did not observe any recurrence of polyarteritis nodosa or membranoproliferative glomerulonephritis.

The group concluded that although they realized that patient cohort is quite small, the recurrence rate was compatible with what was seen already in previously published reports. They additionally recommended that these patients be screened for all risk factors for thrombosis and given appropriate anticoagulation when deemed at high risk. They also state that inpatients with focal segmental glomerulosclerosis retransplantation prophylactic plasmapheresis has been reported to be successful but their two patients who had this recurrence did not receive pretransplant plasmapheresis and this could be a thought in the future to help prevent this type of recurrence.

Bilginer Y, Topaloglu R, Aki FT, Demirkaya E, Ozaltin F, Besbas N, Ozen S, Bakkaloglu A, Erkan I, Bakkaloglu M

Reported by UroToday Medical Editor Pasquale Casale

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