Recurrent FSGS after transplant — ESENeph MCQ

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HardRenal TransplantationRecurrent FSGS after transplantESENeph

Within 72 hours of kidney transplantation, a recipient whose native disease was primary FSGS develops abrupt nephrotic-range proteinuria with preserved graft perfusion. What is the leading diagnosis?

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Correct answer: C — Early recurrence of primary FSGS in the allograft

The best answer is “Early recurrence of primary FSGS in the allograft”. Primary FSGS can recur within hours to days because of a circulating permeability factor. Abrupt nephrotic proteinuria is the hallmark; biopsy with electron microscopy and exclusion of surgical causes support the diagnosis. “Chronic antibody-mediated rejection” is less appropriate because this does not usually present within 72 hours with isolated massive proteinuria “BK-polyomavirus nephropathy” is less appropriate because BK nephropathy occurs later and is associated with viraemia and tubulointerstitial injury “Calcineurin-inhibitor chronic arteriolopathy” is less appropriate because chronic toxicity cannot develop within three days “Transplant renal artery stenosis” is less appropriate because good perfusion and nephrotic proteinuria favour podocyte disease rather than vascular stenosis

Reference: KDIGO kidney transplant recipient guideline: https://kdigo.org/wp-content/uploads/2022/09/KDIGO-2009-Transplant-Recipient-Guideline-English.pdf