Marked Effect of Steroid-Resistant Focal Sclerotic Nephrotic Syndrome by Concomitant Therapy with LDL-Apheresis and Cyclosporine

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It has recently been reported that low-density lipoprotein apheresis (LDL-A) is effective against nephrotic syndrome due to focal gromerulosclerosis (FGS). This study concerns our experience with a patient with steroid-resistant FGS for whom concomitant therapy with cyclosporin A (CsA) and LDL-A markedly reduced the amount of urinary protein. The blood level of CsA was measured before and 10, 60, and 120 min (the end) after the start of LDL-A, both before and after column passage, in an attempt to determine the effect of LDL-A on CsA level. The patient was a 15-year-old girl with a diagnosis of FGS established as a result of renal biopsy. She was frst treated with steroid pulse therapy without any decrease in the amount of urinary protein (30-50 g/day), and was then switched to concomitant therapy with CsA (100 mg/day) and LDL-A (once per week). When the dose of CsA was increased to 150 mg/day, the amount of urinary protein decreased (10-15 g/day) but her severe proteinuria persisted. The dose of CsA was therefore further increased to 200 mg/day, resulting in a marked decrease in the amount of urinary protein (3-4 g/day). The dose was finally increased to 225 mg/day, with a reduction in the amount of urinary protein to the range of 1.4 to 2.1 g/day. The blood level of CsA at the end of LDL-A rose from 125 to 210 ng/ml. We thus could obtained a good effect by increasing the blood level of CsA to a sufficiently high level. The blood level of CsA during LDL-A fell about 40% from that before LDL-A. We therefore recommend that the dose of CsA be increased to maintain an effective blood level during LDL-A since the CsA is adsorbed by LDL-A.
日本アフェレシス学会の論文
1999-11-30

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