Recurrent FSGS and plasmapheresis after donor transplant
A 30-year old man with ESRD received a cadaver donor transplant. His ESRD was from FSGS at age 13 suggesting primary FSGS. The transplant functioned initially but then developed AKI associated with high levels of proteinuria. Is this time frame too early for recurrent FSGS? While the proteinuria is suggestive of recurrent disease, the AKI suggests rejection. Should the patient get empiric plasmapheresis, or a renal biopsy, or both? Vastly different opinions are offered in this case. What would you do?
Summary provided by Roger Rodby, MD, MS.
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