title: Low-density lipoprotein apheresis therapy for steroid- and cyclosporine-resistant idiopathic membranous nephropathy.
abstract: We herein report three cases of Nephrotic Syndrome (NS) with idiopathic membranous nephropathy (IMN) in which the patients were resistant to steroid (PSL) and cyclosporine (CyA) therapy. All three patients had a high risk of renal failure because of persistently high levels of proteinuria. We performed low-density lipoprotein apheresis (LDL-A) and achieved complete remission in two cases. The third patients developed NS relapse and a deteriorating renal function; however, withdrawal from dialysis therapy was achieved. There are no proven therapies for treating patients with PSL- and CyA-resistant IMN with acute deteriorating renal function or difficulties in maintaining fluid balance. We evaluated the treatment course and physiological mechanisms and reviewed similar cases in the pertinent literature.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan. y_s@d2.dion.ne.jp
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Sato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tsunoda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nozue
authors.forename: Qinya
authors.initials: Q
authors.lastname: Pan
authors.forename: Harue
authors.initials: H
authors.lastname: Wakasugi
authors.forename: Ashio
authors.initials: A
authors.lastname: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D001781:Blood Component Removal / Q000379:methods*; D016572:Cyclosporine / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D015433:Glomerulonephritis, Membranous / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008077:Lipoproteins, LDL; D008297:Male; D012008:Recurrence; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000502:physiology
chemical_list: D008077:Lipoproteins, LDL; D013256:Steroids; D016572:Cyclosporine