Plasmapheresis in the treatment of steroid-resistant focal segmental glomerulosclerosis.
A patient presented with a severe nephrotic syndrome and a renal biopsy consistent with early focal segmental glomerulosclerosis (FSGS). After a year of intensive immunosuppressive therapy proteinuria was unabated and renal function began to deteriorate. Treatment with weekly plasmapheresis combined with moderate doses of prednisone and azathioprine produced a dramatic decrease in proteinuria and serum creatinine. A marked fall in the B-cell population occurred during treatment, as well as an increase both in T-lymphocytes of the mature CD4+ helper/suppressor phenotype and in the immature/cytotoxic CD8+ phenotype. Activation of the immune system during treatment was demonstrated by an increase in the rate of spontaneous proliferation of peripheral blood mononuclear cells and an increase in T-cell expression of the interleukin-2 receptor.
Ginsburg
D S
DS
Department of Medicine, Highland Park Hospital, IL, USA.
Dau
P
P
D000328:Adult; D004351:Drug Resistance; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D006801:Humans; D016130:Immunophenotyping; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016131:Lymphocyte Subsets / Q000276:immunology; D010956:Plasmapheresis; D011507:Proteinuria / Q000628:therapy; D013256:Steroids / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D013256:Steroids