Treatment of kidney transplant recipients with recurrent FSGS

FSGS: focal segmental glomerulosclerosis.
* Recurrent FSGS is the development of primary FSGS in the transplanted kidney in patients with primary FSGS as the cause of end-stage kidney disease in the native kidneys.
¶ Among patients with recurrent FSGS who present with a later onset (ie, >3 months) after transplantation, differentiation between recurrent primary FSGS and de novo secondary FSGS may be challenging. It is particularly important to distinguish true recurrent primary FSGS from secondary causes of FSGS, which are unlikely to respond to therapies used to treat recurrent primary FSGS.
Δ In patients with an identifiable cause of secondary FSGS, initial therapy should be directed against the underlying cause since resolution of the FSGS usually occurs after addressing the underlying cause. As examples, patients with evidence of a viral infection that may cause FSGS should be treated for the viral infection, if possible. Patients who are taking a medication that is known to be associated with FSGS should discontinue this agent to see if proteinuria responds.
◊ A partial remission is defined as a reduction in proteinuria ≥50% to a level between 0.3 and 3.5 g/day.