Hemoperfusion with polymyxin B-immobilized fiber in septic patients with methicillin-resistant Staphylococcus aureus-associated glomerulonephritis.
OBJECTIVE
We investigated whether urinary podocytes are present in septic patients with methicillin-resistant Staphylococcus aureus (MRSA)-associated glomerulonephritis and whether polymyxin B-immobilized fiber (PMX-F) treatment affects proteinuria and urinary podocyte excretion in these patients.


METHODS
Twenty septic patients with MRSA-associated glomerulonephritis (mean age: 63.7 years) and 80 septic patients whose MRSA infection was not followed by glomerulonephritis (mean age: 60.5 years) were included in this study. All septic patients were treated with fosfomycin sodium, beta-lactams, arbekacin sulfate, and teicoplanin, or a combination of these. Twenty septic patients with MRSA-associated glomerulonephritis were randomly assigned to one of two treatments: PMX-F treatment (group A, n = 10) and conventional treatment (group B, n = 10). PMX-F treatment was repeated twice.


RESULTS
Urinary podocytes and urinary protein excretion were not detected in MRSA septic patients without glomerulonephritis. However, urinary podocytes (1.7 +/- 0.6 cells/ml) and proteinuria (2.6 +/- 0.6 g/d) were detected in the 20 septic patients with MRSA-associated glomerulonephritis. Plasma endotoxin levels were decreased from 13.6 +/- 4.6 pg/ml to 6.6 +/- 2.2 pg/ml (p < 0.05) in group A. Levels in group B, however, showed little difference after treatment. Urinary podocytes were reduced in group A (from 1.8 +/- 0.6 cells/ml to 0.4 +/- 0.2 cells/ml, p < 0.01) as was urinary protein excretion (from 3.0 +/- 0.5 g/d to 0.8 +/- 0.4 g/d, p < 0.01) but urinary podocytes and protein excretion levels showed little difference after treatment in group B.


CONCLUSIONS
PMX-F treatment may be effective in reducing urinary protein and urinary podocyte excretion in septic patients with MRSA-associated glomerulonephritis.
Nakamura
Tsukasa
T
Department of Medicine, Misato Junshin Hospital,Saitama, Japan.
Ushiyama
Chifuyu
C
Suzuki
Yoshimasa
Y
Osada
Shiwori
S
Inoue
Teruo
T
Shoji
Hisataka
H
Hara
Masanori
M
Shimada
Noriaki
N
Koide
Hikaru
H
D004731:Endotoxins / Q000097:blood; D004847:Epithelial Cells / Q000378:metabolism / Q000473:pathology; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000382:microbiology* / Q000652:urine; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D007678:Kidney Glomerulus / Q000098:blood supply / Q000166:cytology / Q000473:pathology; D008297:Male; D016106:Methicillin Resistance / Q000502:physiology*; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011507:Proteinuria / Q000628:therapy; D018805:Sepsis / Q000097:blood / Q000209:etiology* / Q000652:urine; D013203:Staphylococcal Infections / Q000097:blood / Q000150:complications* / Q000378:metabolism* / Q000652:urine; D013211:Staphylococcus aureus / Q000187:drug effects*; D014556:Urine / Q000166:cytology
D004731:Endotoxins; D011112:Polymyxin B