Abstract
Recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation with nephrotic syndrome is a serious problem with a high risk of graft loss. The therapeutic role of renin-angiotensin-system (RAS) blockers in recurrent FSGS is not clear. We present the safety and efficacy of an intensified triple RAS blockade with an ACE-inhibitor, an AT 1 receptor blocker and the direct renin inhibitor aliskiren in a 29-year-old renal transplant recipient with biopsy proven recurrence of FSGS and relapsing severe nephrotic syndrome. We subsequently used full dose ramipril, candesartan and aliskiren under a close monitoring of kidney function and electrolytes and examined the effect on proteinuria, clinical course and tolerability over 12 months. We found a significant and sustained antiproteinuric effect under triple RAS blockade. RAS blockade was generally well tolerated. This can offer a new therapeutic approach in selected hypertensive patients with recurrent FSGS.
MeSH terms
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Adult
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Amides / administration & dosage
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Amides / therapeutic use*
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Angiotensin II Type 1 Receptor Blockers / administration & dosage
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Angiotensin II Type 1 Receptor Blockers / therapeutic use*
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Angiotensin-Converting Enzyme Inhibitors / administration & dosage
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Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
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Antibodies, Monoclonal / therapeutic use
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Antibodies, Monoclonal, Murine-Derived
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Benzimidazoles / administration & dosage
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Benzimidazoles / therapeutic use*
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Biphenyl Compounds
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Drug Therapy, Combination
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Female
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Fumarates / administration & dosage
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Fumarates / therapeutic use*
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Glomerulosclerosis, Focal Segmental / complications
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Glomerulosclerosis, Focal Segmental / drug therapy*
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Glomerulosclerosis, Focal Segmental / pathology
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Glomerulosclerosis, Focal Segmental / surgery
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Humans
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Hypertension, Renal / drug therapy*
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Hypertension, Renal / etiology
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Kidney Transplantation*
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Nephrotic Syndrome / drug therapy
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Nephrotic Syndrome / etiology
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Plasma Exchange
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Proteinuria / drug therapy
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Proteinuria / etiology
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Ramipril / administration & dosage
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Ramipril / therapeutic use*
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Recurrence
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Renin / antagonists & inhibitors*
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Renin-Angiotensin System / drug effects*
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Rituximab
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Tetrazoles / administration & dosage
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Tetrazoles / therapeutic use*
Substances
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Amides
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Angiotensin II Type 1 Receptor Blockers
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Angiotensin-Converting Enzyme Inhibitors
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Antibodies, Monoclonal
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Antibodies, Monoclonal, Murine-Derived
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Benzimidazoles
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Biphenyl Compounds
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Fumarates
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Tetrazoles
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Rituximab
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aliskiren
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Renin
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Ramipril
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candesartan