Figure 1722

Serum creatinine concentrations and urinary protein excretion in four patients (A-D) with recurrent nephrotic syndrome after transplantation treated by protein adsorption. Each bar indicates one cycle of treatment and the numbers above the bars indicate the sessions of treatment in that cycle. A number of studies have demonstrated that both plasma exchange and protein adsorption (using protein A sepharose), can decrease urinary protein excretion in recurrent focal segmental glomerulosclerosis [6,7,33]. Four examples are shown here. In this study, protein excretion decreased by 82% but returned to pretreatment levels within 2 months in seven of eight patients. More intensive treatment regimens have led to longer remissions [7]. The nature of the circulating factor responsible for protein leakage is unknown. There are case reports of children with recurrent focal segmental glomerulosclerosis responding to high-dose intravenous cyclosporine with remission of nephrotic syndrome. However, cyclosporine does not prevent recurrence when used as part of the initial immunosuppressive regimen. (Adapted from Dantal and coworkers [6].)

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