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Previous Volume 334:878-883 April 4, 1996 Number 14 Next

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ABSTRACT

Background Heavy proteinuria and progressive renal injury recur after transplantation in up to 40 percent of patients with renal failure caused by idiopathic focal segmental glomerulosclerosis. A circulating factor may be responsible for this recurrence.

Methods To determine whether patients with focal segmental glomerulosclerosis have a circulating factor capable of causing glomerular injury, we tested serum samples from 100 patients with the disorder in an in vitro assay of glomerular permeability to albumin. Of the 56 patients who had undergone renal transplantation, 33 had recurrences. Sixty-four patients, many of whom had undergone transplantation, were being treated with dialysis. Thirty-one patients with other renal diseases and nine normal subjects were also studied.

Results The 33 patients with recurrent focal segmental glomerulosclerosis after transplantation had a higher mean (±SE) value for permeability to albumin (0.47±0.06) than the normal subjects (0.06±0.07) or the patients who did not have recurrences (0.14±0.06). After plasmapheresis in six patients with recurrences, the permeability was reduced (from 0.79±0.06 to 0.10±0.05, P = 0.008), and proteinuria was significantly decreased. Patients with corticosteroid-sensitive nephrotic syndrome or with membranous nephropathy after transplantation had low levels of serum activity. The circulating factor bound to protein A and hydrophobic-interaction columns and had an apparent molecular mass of about 50 kd.

Conclusions A circulating factor found in some patients with focal segmental glomerulosclerosis is associated with recurrent disease after renal transplantation and may be responsible for initiating the renal injury.

Source Information

From the Department of Medicine, Medical College of Wisconsin, Milwaukee (V.J.S., R.S., M.S., E.T.M.); the Department of Medicine, Hennepin County Medical Center, Minneapolis (S.K.S.); Arkansas Children's Hospital, Little Rock (E.E.); the Department of Pediatrics, University of Nebraska Medical Center, Omaha (H.L.); Children's Mercy Hospital, Kansas City, Mo. (B.W.); the Departments of Biochemistry and Molecular Biology (S.G.) and Medicine (A.M.C.), University of Kansas Medical Center, Kansas City; and the Department of Medicine, University of California, San Francisco (M.A., F.V.).

Address reprint requests to Dr. Savin at the Nephrology Division, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, 9200 W. Wisconsin Ave., Milwaukee, WI 53226.

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