Figure 1721

Patients with recurrent focal segmental glomerulosclerosis are at substantially increased risk of developing both acute renal failure (panel A) after transplantation and acute rejection episodes (panel B). In one study, 23 of 26 patients with recurrence developed one or more episodes of rejection, compared with only 11 of 40 patients without recurrence [31]. Although the mechanism for the increased rate of acute dysfunction and rejection is unclear, proteinuria and dyslipidemia may alter the expression of cell surface immunoregulatory molecules and major histocompatibility complex antigens. (Adapted from Kim and coworkers [31].)

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