A 35-year-old patient was diagnosed with biopsy-confirmed, steroid-and rituximab-resistant primary focal-segmental-glomerulosclerosis. While on hemodialysis, diuresis was maintained; proteinuria persisted at 9 g/g creatinine. He underwent kidney transplantation; 2-months post-transplantation, persistent proteinuria (3 g/g creatinine; albuminuria exceeding 50%) was observed. The serum creatinine level was 2.2 mg/dL. The kidney-transplant biopsy was normal. Technetium-99m-dimercaptosuccinic-acid (DMSA) renal scan revealed that native kidneys contributed to 30% of renal function. Irbesartan 150 mg/d/dapagliflozin 10 mg/d was started. Six months post-transplantation, proteinuria progressively increased to 7 to 8 g/g. We therefore decided to implement daily immunoadsorption sessions (11 sessions) followed by rituximab (1 infusion of 350 mg/m²). This allowed partial remission.
Trincal et al. (Fri,) studied this question.