Plasmapheresis-induced remission in otherwise therapy-resistant FSGS

We report an 8-year-old Caucasian boy who presented with steroid-resistant nephrotic syndrome. Renal biopsy showed the cellular variant of focal segme ntal glomerulosclerosis (FSGS). Within 1 year he received a series of thera pies that have induced remission in other patients with this disease, all t o no avail (conventional-dose cyclosporin A, methylprednisolone pulse thera py, high-dose cyclosporin A, and therapy with mycophenolate mofetil). He ac hieved remission after five sessions of plasma exchange. This case argues f or aggressive therapy of resistant nephrotic syndrome in the native kidney. Plasma exchange should be considered as a possible rescue therapy arm in f uture study protocols.