Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study.
BACKGROUND
No established therapy is available for patients with lipoprotein glomerulopathy (LPG). Protein A immunoadsorption has been proved to be effective in reducing proteinuria in patients with nephrotic syndrome. In this uncontrolled pilot study, we investigated the efficiency of immunoadsorption onto staphylococcal protein A as treatment for LPG.


METHODS
Thirteen patients with renal biopsy-proven LPG were treated with staphylococcal protein A immunoadsorption. Immunoadsorption was administered for 10 cycles per session and 10 sessions as a course. A total of 30 l of plasma was regenerated in each course.


RESULTS
Single immunoadsorption course led to a rapid decline in proteinuria from 4.01 +/- 3.09 g/24 h to 1.21 +/- 0.97 g/24 h (mean +/- SD) (n = 13, P = 0.001), along with a dramatic decline in apolipoprotein E (apo E) from 9.79 +/- 5.04 mg/dl to 6.20 +/- 2.22 mg/dl (P = 0.004). A repeated renal biopsy (n = 12) showed that intraglomerular lipoprotein thrombi almost disappeared. Six patients were enrolled in the investigation of long-term outcome, and proteinuria returned to baseline levels within 12 months. Four recurrent patients received repeat immunoadsorption treatment; proteinuria decreased from 5.02 +/- 1.85 g/24 h to 1.64 +/- 0.55 g/24 h at the end of the treatment, serum apo E decreased from 14.65 +/- 11.17 mg/dl to 7.90 +/- 1.72 mg/dl. No patients suffered from severe complications.


CONCLUSIONS
Our observations suggest that immunoadsorption onto protein A might be an effective treatment for resolving intraglomerular thrombi and improving nephrotic syndrome in patients with LPG. Further studies are required to define the influence of immunoadsorption on long-term effects in LPG patients.
Xin
Zhang
Z
Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China.
Zhihong
Liu
L
Shijun
Li
L
Jinfeng
Zhan
Z
Huiping
Chen
C
Caihong
Zeng
Z
Daxi
Ji
J
Leishi
Li
L
D000293:Adolescent; D000328:Adult; D001057:Apolipoproteins E / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000473:pathology / Q000628:therapy*; D010865:Pilot Projects; D010956:Plasmapheresis / Q000379:methods*; D011507:Proteinuria / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D013205:Staphylococcal Protein A / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D001057:Apolipoproteins E; D013205:Staphylococcal Protein A