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Recurrent FSGS Post-Transplant — ESENeph MCQ

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HardTransplantationRecurrent FSGS Post-TransplantESENeph

A 42-year-old woman with focal segmental glomerulosclerosis (FSGS) has a recurrence of nephrotic syndrome 2 weeks after a deceased donor kidney transplant. Her native kidney disease was primary FSGS with rapid progression. Proteinuria is 8 g/day. What is the most appropriate initial treatment for recurrent FSGS?

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Correct answer: B — Plasma exchange (plasmapheresis)

Recurrent FSGS post-transplant occurs in 20-40% of patients with primary FSGS and can occur within days to weeks. First-line treatment is plasma exchange (plasmapheresis) to remove the putative circulating permeability factor (suPAR or other factors). Response rates vary. Rituximab has been used as adjunctive therapy. High-dose steroids and CNI optimisation are supportive but plasma exchange is the primary intervention. Early treatment is important for graft survival.

Reference: KDIGO 2021 – Glomerular Disease Guideline; Uffing et al 2021 – Recurrent FSGS Review