Successful Anti-TNFα Treatment in a Child with Posttransplant Recurrent Focal Segmental Glomerulosclerosis

Posttransplant recurrence of focal and segmental glomulosclerosis (FSGS) occurs in similar to 30% of patients, and remains after uncontrolled despite increased immunosuppression and plasma exchanges (PE) in similar to 30% of cases. New immunosuppressive drugs might then be warranted. We report the case of a 15-year-old boy with FSGS leading to end-stage renal disease (ESRD) who presented with an early posttransplant recurrence of disease. Reinforced immunosuppression and PE resulted in partial and transient disease control, but proteinuria significantly decreased with anti-TNF alpha treatment (infliximab then etanercep). This is the first case report of successful anti-TNF alpha treatment despite a constant high activity of FSGS, as demonstrated by relapse after discontinuation of anti-TNF alpha agents.