ArticlePediatric nephrology (Berlin, Germany)2026
Monogenic variants drive low recurrence risk in pediatric steroid-resistant nephrotic syndrome after kidney transplantation: a high-consanguinity cohort.
Article in Pediatric nephrology (Berlin, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSteroid-resistant nephrotic syndrome (SRNS) is a leading cause of stage 5 chronic kidney disease (CKD 5) in children and carries a substantial risk of post-transplant disease recurrence. Data from the Arabian Peninsula are sparse.
methodsThis retrospective cohort study included all paediatric patients (aged < 18 years) who underwent a first kidney transplant at King Fahad Specialist Hospital-Dammam between January 2008 and December 2023 with a confirmed diagnosis of SRNS, focal segmental glomerulosclerosis (FSGS), congenital nephrotic syndrome, or a pathogenic monogenic variant known to cause SRNS. Patients were classified as having genetic or non-genetic SRNS according to next-generation sequencing results. Primary outcomes were post-transplant recurrence rate and graft survival. Secondary outcomes included estimated glomerular filtration rate (eGFR) values and treatment response.
resultsAmong 208 paediatric kidney transplant recipients, 60 (28.8%) had CKD 5 attributable to SRNS/FSGS. Genetic testing (performed in 59/60 patients, 98.3%) identified pathogenic variants in 44 patients (74.6%); NPHS2 was most prevalent (28.8%). Post-transplant recurrence occurred in 6 patients (10%): 5 of 15 in the non-genetic group (33%) and 1 of 44 in the genetic group (2.3%) (p < 0.001). All six patients with recurrence received plasmapheresis; five also received rituximab. Complete remission was achieved in 5 patients (83%) and partial remission in 1 (17%). The 5-year graft survival rate was 98% overall-100% in the genetic group versus 93% in the non-genetic group (log-rank p = 0.21). The eGFR at 5 years was significantly higher in the genetic group (73.5 ± 17.6 vs. 60.6 ± 22.9 mL/min/1.73 m
conclusionsSRNS/FSGS accounts for approximately 29% of paediatric CKD 5 in this cohort and is characterised by a high prevalence of monogenic variants reflecting regional consanguinity. Genetic testing reliably stratifies recurrence risk: non-genetic SRNS carries a substantially higher recurrence rate, yet combined plasmapheresis and rituximab achieves remission in most affected patients. Graft outcomes are comparable to those seen in other CKD 5 aetiologies.
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