Successful Anti‐TNFα Treatment in a Child with Posttransplant Recurrent Focal Segmental Glomerulosclerosis

Posttransplant recurrence of focal and segmental glomulosclerosis (FSGS) occurs in ∼30% of patients, and remains after uncontrolled despite increased immunosuppression and plasma exchanges (PE) in ∼30% of cases. New immunosuppressive drugs might then be warranted. We report the case of a 15‐year‐old boy with FSGS leading to end‐stage renal disease (ESRD) who presented with an early posttransplant recurrence of disease. Reinforced immunosuppression and PE resulted in partial and transient disease control, but proteinuria significantly decreased with anti‐TNFα treatment (infliximab then etanercep). This is the first case report of successful anti‐TNFα treatment despite a constant high activity of FSGS, as demonstrated by relapse after discontinuation of anti‐TNFα agents.

[1]  L. Tomlinson,et al.  Granulomatous interstitial nephritis treated with a tumour necrosis factor-α inhibitor , 2006 .

[2]  M. Pescovitz,et al.  Resolution of recurrent focal segmental glomerulosclerosis proteinuria after rituximab treatment. , 2006, The New England journal of medicine.

[3]  L. Tomlinson,et al.  Granulomatous interstitial nephritis treated with a tumour necrosis factor-alpha inhibitor. , 2006, Nephrology, Dialysis and Transplantation.

[4]  G. Ciancio,et al.  Recurrent focal glomerulosclerosis in pediatric renal allografts: the Miami experience , 2005, Pediatric Nephrology.

[5]  D. Raveh,et al.  Tumor necrosis factor-α blocking agent as a treatment for nephrotic syndrome , 2004, Pediatric Nephrology.

[6]  J. G. van den Berg,et al.  Role of the immune system in the pathogenesis of idiopathic nephrotic syndrome. , 2004, Clinical science.

[7]  L. Travis,et al.  High-dose oral cyclosporin therapy for recurrent focal segmental glomerulosclerosis in children. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[8]  D. Raveh,et al.  Tumor necrosis factor-alpha blocking agent as a treatment for nephrotic syndrome. , 2004, Pediatric nephrology.

[9]  A. Bakr,et al.  Tumor necrosis factor-α production from mononuclear cells in nephrotic syndrome , 2003, Pediatric Nephrology.

[10]  E. Lerut,et al.  Benefit of anti-TNF a treatment for nephrotic syndrome in a patient with juvenile inflammatory bowel disease associated spondyloarthropathy complicated with amyloidosis and glomerulonephritis , 2003 .

[11]  A. Bakr,et al.  Tumor necrosis factor-alpha production from mononuclear cells in nephrotic syndrome. , 2003, Pediatric nephrology.

[12]  R. Busund,et al.  Plasmapheresis in severe sepsis and septic shock: a prospective, randomised, controlled trial , 2002, Intensive Care Medicine.

[13]  E. Drewe,et al.  Treatment of the nephrotic syndrome with etanercept in patients with the tumor necrosis factor receptor-associated periodic syndrome. , 2000, The New England journal of medicine.

[14]  S. Kim,et al.  Early recurrent nephrotic syndrome after renal transplantation in children with focal segmental glomerulosclerosis. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[15]  V. Savin,et al.  TNF-alpha increases albumin permeability of isolated rat glomeruli through the generation of superoxide. , 1998, Journal of the American Society of Nephrology : JASN.

[16]  H. Ha,et al.  Role of tumor necrosis factor-alpha on mesangial cell MCP-1 expression and monocyte migration: mechanisms mediated by signal transduction. , 1996, Journal of the American Society of Nephrology : JASN.

[17]  V. Savin,et al.  Plasmapheresis reduces proteinuria and serum capacity to injure glomeruli in patients with recurrent focal glomerulosclerosis. , 1994, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[18]  B. Myers,et al.  Elevated Levels of Tumor Necrosis Factor-α in the Nephrotic Syndrome in Humans , 1993 .

[19]  B. Myers,et al.  Elevated levels of tumor necrosis factor-alpha in the nephrotic syndrome in humans. , 1993, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  J. Cameron,et al.  Recurrence of focal segmental glomerulosclerosis in renal allografts. , 1981, Transplantation.