PMC4836136_01
Case 1, treatment course. Arrows depict therapeutic plasma exchange procedures.
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F1
The patient's treatment course is depicted in figure 1.
Histologic response. The pretreatment biopsy demonstrates moderate effacement (arrow) of the foot processes of the glomerular visceral epithelial cells and microvillous transformation changes, evidence of recurrent FSGS. There were patent capillary loops, normal endothelial fenestration, and no immune deposits. There was effacement of approximately half of the epithelial cell foot processes on electron microscopy. After improvement of Pr:Cr ratio from plasma exchange therapy, the posttreatment glomeruli show features of epithelial foot process recovery. There is markedly less effacement and minimal microvillous transformation changes. Electron microscopy shows less than one quarter of the foot processes effaced and the majority having a normal arrangement.
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F2
Pretreatment and posttreatment biopsies are depicted in figure 2.
PMC4836136_02
Case 2, treatment course. Arrows depict therapeutic plasma exchange procedures.
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F3
Therapeutic plasma exchange was initiated on posttransplant day 4 and continued forward as noted in figure 3.