Does LDL-apheresis in steroid-resistant nephrotic syndrome affect prognosis?
Low-density lipoprotein apheresis (LDL-A) was performed for nine episodes of steroid-resistant nephrotic syndrome in eight patients. The clinical and immunohistological findings were analysed retrospectively. Six of the patients had focal glomerular sclerosis (FGS), one had minimal-change nephrotic syndrome (MCNS), and one had membranous nephropathy (MN) with FGS. The LDL-A treatment, carried out 2-13 times (mean 7.33 +/- 4.05) for one nephrotic episode, at average intervals of 3-16 days (mean: 8.5 +/- 5.1 days) and combined with steroid pulse therapy and the administration of an antihyperlipidaemic agent in some cases, led to rapid amelioration of hyperlipidaemia. In six nephrotic episodes (5 patients) more than 50% reduction of proteinuria occurred (less than 3.5 g/day) (response-group). A significant elevation of serum albumin (more than 3.0 g/dl) was obtained in five of these episodes. The other three patients were resistant (resistant-group). The number of and intervals between LDL-A treatments in the response group (5 +/- 2.8 times and 5.8 +/- 4.1 days) were significantly less than those in the resistant-group (12.0 +/- 0.8 times and 13.2 +/- 1.8 days) (P < 0.05). After LDL-A, significant reductions were observed in the serum total cholesterol (T-CHO), phospholipid (PL), triglyceride (TG), free-CHO (F-CHO), and beta-lipoprotein (beta-lipo) (P < 0.05). HDL-cholesterol (HDL-C) increased somewhat after LDL-A. Further, Ccr was elevated in all nephrotic episodes, except in one patient who manifested renal failure after 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)
Muso
E
E
Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
Yashiro
M
M
Matsushima
M
M
Yoshida
H
H
Sawanishi
K
K
Sasayama
S
S
D000293:Adolescent; D000328:Adult; D001055:Apolipoproteins B / Q000378:metabolism; D001057:Apolipoproteins E / Q000378:metabolism; D001781:Blood Component Removal; D004351:Drug Resistance; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000097:blood / Q000628:therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000097:blood / Q000473:pathology / Q000628:therapy; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification*; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000097:blood / Q000628:therapy; D009404:Nephrotic Syndrome / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D011379:Prognosis; D013256:Steroids / Q000627:therapeutic use
D001055:Apolipoproteins B; D001057:Apolipoproteins E; D008077:Lipoproteins, LDL; D013256:Steroids