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NDT Advance Access published online on September 22, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp500
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© The Author 2009. Published by Oxford University Press [on behalf of ERA-EDTA]. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Recurrence of nephrotic syndrome after transplantation in a mixed population of children and adults: course of glomerular lesions and value of the Columbia classification of histological variants of focal and segmental glomerulosclerosis (FSGS)

Guillaume Canaud1,2, Daniel Dion3, Julien Zuber1,2, Marie-Claire Gubler4, Rebecca Sberro1,2, Eric Thervet1,2, Renaud Snanoudj1, Marina Charbit5, Rémi Salomon2,5, Frank Martinez1, Christophe Legendre1,2, Laure-Helene Noel3 and Patrick Niaudet2,5

1 Department of Kidney Transplantation, Necker Hospital, 149 rue de Sèvres, 75015, Paris 2 Université Paris Descartes, Rue de l’Ecole de Médecine 3 Department of Pathology 4 Institut National de la Santé et de la Recherche Médicale U574 5 Department of Pediatrics Nephrology, Necker Hospital, 149 rue de Sèvres, 75015, Paris, France

Correspondence and offprint requests to: Guillaume Canaud; E-mail: guillaume.canaud{at}nck.aphp.fr



  Abstract

Introduction. Recurrence of nephrotic-range proteinuria in patients with idiopathic nephrotic syndrome (INS) and focal and segmental glomerulosclerosis (FSGS) on native kidneys is associated with poor graft survival. Identification of risk factors for recurrence is therefore an important issue. In 2004, Columbia University introduced a histological classification of FSGS that identifies five mutually exclusive variants. In non-transplant patients, the Columbia classification appears to predict the outcome and response to treatment better than clinical characteristics alone. However, the predictive value of this classification to assess the risk of recurrence after transplantation has not been addressed.

Methods. We retrospectively studied 77 patients with INS and FSGS on native kidneys who underwent renal transplantation. Of these, 42 recipients experienced recurrence of nephrotic range proteinuria.

Results. At time of recurrence, minimal-change disease (MCD) was the main histological feature. On serial biopsies, the incidence of MCD decreased over time, while the incidence of FSGS variants increased. The variant type observed in the native kidneys was not predictive of either recurrence or type of FSGS seen on the allograft. Patients with complete and sustained remission did not developed FSGS.

Conclusion. In conclusion, the Columbia classification is of no help in predicting recurrence after renal transplantation or histological lesions in the case of recurrence of proteinuria.

Keywords: FSGS; histopathology; kidney transplantation; recurrence

Received for publication: 3. 4.09
Accepted in revised form: 28. 8.09


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