LDL adsorption improves the response of focal glomerulosclerosis to corticosteroid therapy.
We investigated the therapeutic effect of low density lipoprotein adsorption (LDL-A) in 14 patients who had focal glomerulosclerosis (FGS) with the nephrotic syndrome resistant to steroids. Patients received a total of 6 sessions (2 times a week for 3 weeks). The levels of total cholesterol, triglycerides and low-density lipoprotein were decreased significantly after treatment (by approximately 50%) in all patients (p<0.01). There also seemed to be a possibility that LDL-A improved the response to steroid therapy. The glomerular filtration rate (GFR) increased from 54.4 +/-27.4 ml/min to 70.0+/-30.2 ml/min (p <0.05) and daily urinary protein excretion (Up/day) decreased from 7.24+/-3.58 g/day to 2.56 + 2.00 g/day (p<0.01). Up/day was significantly higher in patients who showed more than 30% improvement of GFR (n = 6) than in patients who showed less than 30% improvement of GFR (n = 7) (9.50+/-3.41 g/day vs 4.59+/-1.17 g/day, p<0.05). The decrease of urinary protein excretion was more marked in younger patients (29.4+/-11.9 vs 49.7+/-14.8, p <0.05). Only electron microscopy was able to detect histological recovery in the patients who showed a decrease of proteinuria after LDL-A therapy and light microscopy was not able to verify or accurately identify the histological response. In conclusion, LDL-A seems to be effective for FGS associated with nephrotic syndrome resistant to steroids, especially in younger patients. Histological assessment of the effect of this treatment requires electron microscopic examination.
The Second Department of Medicine, The Jikei University School of Medicine, Tokyo, Japan.
K
K
Yokoyama
S
S
Sakai
T
T
Sigematsu
F
F
Takemoto
S
S
Hara
A
A
Yamada
Y
Y
Kawaguchi
T
T
Hosoya
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000327:Adsorption; D000328:Adult; D001707:Biopsy, Needle; D001781:Blood Component Removal; D003131:Combined Modality Therapy; D005260:Female; D005919:Glomerular Filtration Rate; D005923:Glomerulosclerosis, Focal Segmental / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D008077:Lipoproteins, LDL / Q000097:blood / Q000302:isolation & purification*; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D011507:Proteinuria / Q000652:urine
D000305:Adrenal Cortex Hormones; D008077:Lipoproteins, LDL