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.
Yokoyama
K
K
The Second Department of Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Sakai
S
S
Sigematsu
T
T
Takemoto
F
F
Hara
S
S
Yamada
A
A
Kawaguchi
Y
Y
Hosoya
T
T
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