Recurrence of focal segmental glomerulosclerosis in a renal allograft recipient

A 22-year girl, diagnosed to have primary focal segmental glomerulosclerosis in 2009, underwent live related donor renal transplantation in May 2011. Her immunosuppressive regimen included Tacrolimus, Mycophenolate Mofetil and Prednisolone. For next three months graft function remained normal. In August 2011 she developed massive proteinuria with mild graft dysfunction and graft biopsy showed recurrence of focal segmental glomerulosclerosis. She underwent nine sessions of plasmapheresis followed by two doses of Rituximab. She attained remission of proteinuria and normal graft function after treatment. She continues to be in remission at one year and six months.