糖尿病性腎症,コレステロール塞栓症に対するLDLアフェレシス(<特集>腎疾患とアフェレシス-最近の知見-)

概要

論文の詳細を見る
Low density lipoprotein (LDL) apheresis is an effective tool for diabetic nephropathy (DMN) and cholesterol crystal embolism (CCE). LDL-apheresis dramatically decreased urinary protein excretion in patients with DMN accompanied by high LDL cholesterol, and long-term intermittent treatment with LDL-apheresis retarded the progression of overt high proteinuric DMN. In CCE, LDL-apheresis monotherapy or combined therapy with a small amount of steroid could stabilize or improve renal disturbance caused by CCE. These clinical effects may be brought by several actions of LDL-apheresis, i.e., the inhibitory effect of lipid-mediated vicious renal damage, the inhibitory effect of inflammatory cytokine production and macrophage infiltration to renal tissue, the vasodilatory effect leading to alteration of renal hemodinamics, and stabilization and/or regression of atheromatous plaque. The term "LDL-apheresis" means rapid LDL removal from the blood. However, LDL-apheresis has various effects beyond lowering lipids, and may be a promising tool for treating intractable massive proteinuria in overt DMN or renal dysfunction caused by CCE. With due consideration of cost-benefit performance, a randomized controlled clinical trial with a unified protocol is necessary to clarify the benefit of LDL-apheresis for these diseases.
2011-05-31