Recurrence of nephrotic syndrome after renal transplantation: influence of increased immunosuppression

Recurrence of nephrotic syndrome after renal transplantation leads to graft loss within 1 year in 50–80% of patients who do not receive any specific treatment. Several treatment protocols have been proposed leading to long-term remission in 50–80% of patients. The aim of our study was to evaluate the efficiency of intensified immunosuppression, simultaneously including methylprednisolone pulses, cyclophosphamide, high-dose cyclosporine and plasma exchanges. Fourteen patients with early recurrence were treated with a protracted high-dose prednisone or IV methylprednisolone, oral cyclophosphamide, high-dose oral or IV cyclosporine, and plasma exchanges. By the end of cyclophosphamide therapy and plasma-exchange program, six out of 14 patients had no proteinuria; five had residual proteinuria without nephrotic syndrome and three experienced ongoing gross proteinuria with nephrotic syndrome. By the end of follow-up, four out of the 14 patients had lost their graft: one out of six with complete remission, one out of five with residual proteinuria and two out of three with persistent nephrotic syndrome. We conclude that multiple reinforcement of immunosuppression in patients with recurrent nephrotic syndrome following renal transplantation as performed in our patients is not more efficient than the single use of cyclophosphamide or plasma exchange or high-dose cyclosporine as reported in the literature.