Unconventional strategies in the battle of focal and segmental glomerulosclerosis

الملخص EN

A 24-year-old male presented with classic features of the nephrotic syndrome.

An initial renal biopsy revealed minimal change disease and thereafter, a second biopsy showed features of focal and segmental glomerulosclerosis.

There was no response to conventional immunosuppression, and the patient had to be given rituximab; in spite of this, he went on to develop end-stage renal disease.

He continued to have heavy proteinuria leading to severe hypo- albuminemia, thrombosis, infections, and malnutrition, placing the patient in a life-threatening situation.

Bilateral renal ablation with embolization of both kidneys with coiling was done at one setting, which finally resolved the proteinuria in the patient.

He then underwent a living-related renal transplant, developing recurrence immediately post-transplant.

He was again given ritu- ximab along with tacrolimus, mycophenolate mofetil, and prednisolone.

There was no response to rituximab, and the patient underwent plasmapheresis, which leads to complete remission.

An arteriovenous fistula was created post-transplant to facilitate regular plasmapheresis.