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| De novo cellular FSGS after renal transplantation |
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| Department of Pathology, University of Tsukuba |
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| Department of Pathology, Tokyo Women's Medical University |
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Shigeru Horita, Yutaka Yamaguchi |
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| Department of Urology, Tokyo Women's Medical University |
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Kazunari Tanabe, Hiroshi Tohma |
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Focal segmental glomerulosclerosis (FSGS) is the pathological entity non-specifically found in the variety of glomerular diseases. FSGS could be also found in the various post-transplant settings, including donor-derived, infection-related, ischemia-induced, CyA－induced, hypertensive/vascular rejection-related and post transplant glomerulonephritis-associated changes. Thus, the term "de novo FSGS" is quite confusing, since FSGS in this occasion means idiopathic focal segmental sclerosis (idiopathic FGS) which is disease entity but not pathological one. De novo idiopathic FSGS should be carefully diagnosed with some specific pathological changes for idiopathic FSGS.
We present a case of post transplant nephrotic syndrome in 22 year-old male. Native kidney disease was biopsy proven Alport syndrome and mother donated renal transplantation was performed after 2 years of HD at 20 years old. Proteinuria appeared at 3+ level of spot sample after 4 months of Tx and reached nephrotic range (4.5 g/day) at 6 months after Tx. Renal biopsy revealed FSGS with cellular lesions which are some specific glomerular changes in the early stage of idiopathic FSGS or HIV related FSGS and unlikely for non-specific "classical" changes of FSGS. Based on the specific glomerular lesions for idiopathic FSGS and checking several factors possibly involve occurrence of FSGS, we discuss cellular FSGS after renal transplantation. |
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