Management of recurrent focal segmental glomerulosclerosis (FSGS) post renal transplantation.

BACKGROUND: One of the common GN causing ESKD is focal segmental glomerulosclerosis (FSGS). Recurrence of FSGS post-transplantation can lead to graft loss. Data on management either prophylactically or once recurrence occurs are limited. This review article aims to assess the effective management of patients with FSGS recurrence post-transplantation, looking mainly at recurrence post prophylactic treatment and remission in case of treatment post recurrence. METHODS: Twenty-three studies were included using the search MeSH terms "FSGS" "recurrence" "adults" "transplantation" "treatment". Search engines used were Pubmed, clinical key, Scopus and Cochrane library. Inclusion criteria were articles covered adult patients with recurrent FSGS post renal transplantation, treatment with rituximab and plasmapheresis, and articles published from 2000 tt2021. Excluded articles were paediatric population, studies with no reported outcomes of the treatment of FSGS, and Patients who received stem cell transplantation or galactose therapy. RESULTS: Prophylactic PP did not show a reduction in recurrence of FSGS in 2/3 studies. Prophylactic rituximab was shown to reduce recurrence of FSGS in one-study and case reports. Treatment of recurrent FSGS with PP showed responses ranging from 41% to 100%. Only one study did not show improvement with PP use as treatment having a 27% remission. Treatment with rituximab showed variable results, with reports showing remission ranging from 57% to 100%. Whereas other reports showing no response at all. PP prescription reporting was variable. One study suggested intensified PP regimen while in most other studies PP was guided by the response reflected by the reduction of proteinuria. DISCUSSION: Reviewing the treatment of recurrent FSGS is crucial, as there no consensus on treating FSGS as the disease is not very common in the adult population. The evidence of different modalities is based on small cohort studies. This paper supports the use of PP and RTX as treatment of recurrent FSGS. CONCLUSIONS: In conclusion, PP and RTX are the main modalities to treat recurrent FSGS with varying response rates. Prophylactic PP does not play a role in preventing recurrent FSGS. Prophylactic rituximab might play a role in preventing FSGS post-transplantation. PP and RTX, when used as a treatment, show variable response rates. Larger RCTs are needed to have a strong level of evidence to base our clinical management on.

Multicenter Review of Glomerular Diseases in the Emirates of Abu Dhabi: Six Years' Experience.

Glomerulonephritis (GN) is a rising paramount renal disease that varies in etiology from inherited or acquired factors. Its severity can range from asymptomatic depictions to end-stage renal disease. The aim of this study was to study the patterns of biopsy-proven GN based on the data from a multicenter in Abu Dhabi. Included kidney biopsies were from all patients above the age of 18 years, over a six-year period from 2010 to 2015, who had diagnosis of glomerular disease other than diabetes mellitus. The number of reviewed biopsies was 416. The most common type of GN among the study sample was IgA GN (22.8%) followed by focal segmental glomerulosclerosis (20.4%) and systemic lupus erythematosus (SLE) (19.7%). The least common types were pauciimmune (1.7%). There was female preponderance in lupus nephritis and pauciimmune GN. The nationality comparison did not reveal a predominate GN among Emirati nationals. The age relationship to GN types showed that majority (82.9%) of SLE patients, MCD (74.55%), and noncategorized (71.4%) patients are young aged between 18 and 39 years. On the other hand, 57.1%, 25%, and 16.7% of patients with pauciimmune, other GN types, and membranoproliferative GN, respectively, are 60 years and older. This study shows the histopathological variety of glomerular disease in Abu Dhabi. It could be a driving point to help understand GN better in the region.

Metabolic dysfunction in Emirati subjects in Abu Dhabi: Relationship to levels of soluble RAGEs.

BACKGROUND: The United Arab Emirates is experiencing increasing rates of type 2 diabetes (T2D) and its complications. As soluble levels of the receptor for advanced glycation end products, (sRAGE), and endogenous secretory RAGE (esRAGE), the latter an alternatively spliced form of AGER (the gene encoding RAGE), have been reported to be associated with T2D and its complications, we tested for potential relationships between these factors and T2D status in Emirati subjects. METHODS: In a case-control study, we recruited Emirati subjects with T2D and controls from the Sheikh Khalifa Medical City in Abu Dhabi. Anthropomorphic characteristics, levels of plasma sRAGE and esRAGE, and routine chemistry variables were measured. RESULTS: Two hundred and sixteen T2D subjects and 215 control subjects (mean age, 57.4 ±â€¯12.1 vs. 50.7 ±â€¯15.4 years; P < 0.0001, respectively) were enrolled. Univariate analyses showed that levels of sRAGE were significantly lower in the T2D vs. control subjects (1033.9 ±â€¯545.3 vs. 1169.2 ±â€¯664.1 pg/ml, respectively; P = 0.02). Multivariate analyses adjusting for age, sex, systolic blood pressure, pulse, body mass index, Waist/Hip circumference ratio, fasting blood glucose, HDL, LDL, insulin, triglycerides, Vitamin D and urea levels revealed that the difference in sRAGE levels between T2D and control subjects remained statistically-significant, P = 0.03, but not after including estimated glomerular filtration rate in the model, P = 0.14. There were no significant differences in levels of esRAGE. Levels of plasma insulin were significantly higher in the control vs. the T2D subjects (133.6 ±â€¯149.9 vs. 107.6 ±â€¯93.3 pg/L. respectively; P = 0.01, after adjustment for age and sex). CONCLUSION/DISCUSSION: Levels of sRAGE, but not esRAGE, were associated with T2D status in Abu Dhabi, but not after correction for eGFR. Elevated levels of plasma insulin in both control and T2D subjects suggests the presence of metabolic dysfunction, even in subjects without diabetes.