Ciclosporin
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Focal segmental glomerulosclerosis: case report A 35-year-old woman developed focal segmental glomerulosclerosis (FSGS) following immunosuppressive drug therapy with ciclosporin. The woman, who had FSGS progressed to end-stage renal disease, underwent a renal transplantation. At the time of transplant, she had been initiated on immunosuppressive drug therapy with ciclosporin [route and dosage not stated] along with mycophenolate and unspecified steroids. During the 1st year of transplantation, her creatinine had been 0.7 mg/dL without proteinuria. Ciclosporin had been discontinued at the end of the 1st year. Further maintenance was achieved by mycophenolate and prednisone. At the time of her 18th annual visit, she had proteinuria (1.8 g/day). Her immunosuppression was continued and she received an unspecified angiotensin receptor blocker. Eventually, the woman’s proteinuria improved to 0.8 g/day. After 2 months, a renal biopsy revealed focal global and FSGS along with patchy interstitial fibrosis, tubular atrophy with associated nonspecific inflammation, hyaline arteriolosclerosis and mild arteriosclerosis. She was found to have developed a recurrence of FSGS. Electron microscopy revealed podocyte foot process effacement. Genotype testing showed that she inherited a G1 and a G2 risk variant of APOL1. It was concluded that risk variant of APOL1 gene, cold ischaemia time and exposure to ciclosporin had contributed in the recurrence of FSGS, triggering the disease 18 years after the initial transplant. Author comment: "A second hit, such as infections, are proposed to be triggers for the development of the disease [FSGS]. . .cold ischemia time and exposure to calcineurin inhibitor [ciclosporin] may be associated with the second hit". Mirza A, et al. Transplantation With APOL1 Risk Variant Kidney May Be Associated With Lifetime Risk for Recurrence of Focal Segmental Glomerulosclerosis: A Case Report and Review of Literature. Transplantation Proceedings 51: 3077-3079, No. 9, Nov 2019. Available from: URL: http:// 803437658 doi.org/10.1016/j.transproceed.2019.04.056 - USA
0114-9954/19/1782-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 7 Dec 2019 No. 1782
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