The beneficial effects of lymphocytapheresis for treatment of nephrotic syndrome.
A considerable permeability factor (or factors) derived from circulating T cells has a crucial role in proteinuria of nephrotic syndrome (NS). We attempted to remove pathogenic T cells through lymphocytapheresis (LCAP) in 6 patients with primary NS, 2 patients with minimal change nephrotic syndrome (MCNS), 2 patients with focal segmental glomerulosclerosis (FSGS), 1 patient with membranous nephropathy (MN), and 1 patient with MN and FSGS using Cellsorba (Asahi Medical Co., Osaka, Japan). LCAP was performed 2 times in 2 consecutive weeks and was followed with corticosteroid therapy with or without cyclosporine A in 5 patients. Two patients with MCNS, 1 with FSGS, and 1 with MN and FSGS showed a dramatic decrease of proteinuria (-30% and -94%) in their urine protein/creatinine ratio. Three out of 4 patients had a complete or partial remission (proteinuria <1g/day) within 8 weeks following immunosuppressive therapy. During the LCAP, T cells, especially activated T cells, decreased significantly in the response group. The other 2 patients, 1 with FSGS and 1 with MN, however, had no response to LCAP and following immunosuppressive therapy or low-density lipoprotein apheresis and suffered from end-stage renal failure or death by pneumonia. These results suggested that LCAP might have a beneficial effect on the treatment of NS, especially MCNS and in some patients with FSGS, despite varying responses to LCAP and concomitant immunosuppressive therapy.
Yokoyama
Hitoshi
H
Department of Gastroenterology and Nephrology and Division of Blood Purification, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. dialysis@medf.m.kanazawa-u.ac.jp
Shimizu
Miho
M
Wada
Takashi
T
Yoshimoto
Keiichi
K
Iwata
Yasunori
Y
Shimizu
Kazuaki
K
Sakai
Norihiko
N
Furuichi
Kengo
K
Hisada
Yukimasa
Y
Takakuwa
Hiroshi
H
Kobayashi
Ken-Ichi
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D015433:Glomerulonephritis, Membranous / Q000628:therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy; D007937:Leukapheresis; D009404:Nephrotic Syndrome / Q000628:therapy*; D011507:Proteinuria / Q000628:therapy; D013601:T-Lymphocytes; D016896:Treatment Outcome