Recurrence of focal segmental glomerulosclerosis: An updated review of pathophysiology, biomarkers, and therapeutic strategies - PubMed

6 hours ago

FSGS recurrence (rFSGS) occurs in 30%-40% of patients post-kidney transplant, often presenting with nephrotic-range proteinuria soon after.
Primary FSGS is strongly linked to rFSGS due to circulating factors or immune dysfunction damaging podocytes, while genetic causes like APOL1 have variable recurrence.
Biomarkers for early detection include anti-nephrin antibodies, anti-CD40 antibodies, sTNFR2, and suPAR.
Post-transplant monitoring involves UPCR, 24-hour urine protein, and kidney biopsy.
Preventive strategies like plasmapheresis and rituximab show limited benefit and are not routine.
Treatment includes plasmapheresis, immunoadsorption, and drugs such as cyclophosphamide, rituximab, or calcineurin inhibitors.
Managing rFSGS requires genetic testing, risk stratification, early biomarker detection, and prompt treatment to preserve graft survival, but standardized strategies need more research.

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