Recurrence of idiopathic nephrotic syndrome after renal transplantation (Reprinted from The Lancet vol 2, pg 343-348, 1972)

Three patients with steroid-resistant idiopathic nephrotic syndrome were st udied at onset and during recurrent nephrotic syndrome after renal transpla ntation. Renal biopsies at the onset of the nephrotic syndrome showed typic al features of the idiopathic nephrotic syndrome; no or minimal focal glome rular abnormalities were present by light microscopy and glomerular-basemen t-oriented deposits were not demonstrated by immunofluorescent or electron microscopy. Progression to renal failure occurred in 2, 2, and 6 years. Rec urrence of nephrotic syndrome was noted 1 1 1/2 and 5 months after transpla ntation Renal biopsies done 1 1/2, 5, and 7 months after transplantation wh en proteinuria was 12.8. 7.6, and 8.5 g. per 24 hours, respectively, showed minimal or no glomerular abnormalities by light microscopy. Immunofluoresc ent and electron microscopic studies revealed no evidence suggesting immuno logical injury. Subsequent kidney specimens after transplantation obtained from two of these patients with recurrent nephrotic syndrome showed focal s egmental glomerulosclerosis limited primarily to the juxtamedullary glomeru li-a feature further suggesting recurrence of the original disease in the t ransplanted kidney. These observations suggest that the pathogenesis of the steroid-resistant idiopathic nephrotic syndrome may involve systemic circu lating factors; this hypothesis would account for development of a recurren t nephrotic syndrome in the transplanted kidney.