A case report of XXXX to treat recurrent @entity8 post-transplantation and biomarker monitoring.

@entity1 @entity4545 @entity8 @entity644 @entity3649 @entity810 @entity1011 @entity230 @entity7743
BACKGROUND: Recurrent @entity8 (rFSGS) in renal transplant recipients (RTR) is difficult to predict and treat. Early rFSGS is likely from circulating factors and preformed antibodies. METHODS: We present the case of a 23-year-old white @entity1 who presented with rFSGS and @entity810 , requiring dialysis 9-months after a 1-haplotype matched living-related transplant. We retrospectively analyzed serum samples from various clinical stages for rFSGS biomarkers: serum glomerular albumin permeability (Palb), soluble urokinase-type plasminogen activator receptor (suPAR) serum level with suPAR-b3 integrin signaling on @entity1 podocytes, and angiotensin II type I receptor-antibody ( @entity7743 -Ab) titer. RESULTS: All biomarkers were abnormal at 1-year pre-transplant prior to initiation of dialysis and at the time of transplant. After initiation of hemodialysis, b3 integrin activity on @entity1 podocytes, in response to patient serum, as well as @entity7743 -Ab were further elevated. At the time of biopsy-proven recurrence, all biomarkers were abnormally high. One week after therapy with aborted plasmapheresis (secondary to intolerance), and high dose @entity230 , the Palb and suPAR-b3 integrin activity remained significantly positive. After 12-weeks of treatment with high-dose @entity230 , rituximab, and @entity3649 , the @entity1 remained hemodialysis-dependent. Three-months after his initial presentation, we commenced @entity4545 (ACTH, Acthar(  ) Gel), 80 units subcutaneously twice weekly. Four-weeks later, he was able to discontinue dialysis. After 8-months of maintenance ACTH therapy, his serum @entity1011 stabilized at 1.79   mg/dL with <1   g of @entity644 . CONCLUSION: ACTH therapy was associated with improvement in renal function within 4   weeks. The use of rFSGS biomarkers may aid in predicting development of rFSGS.
