LDL-adsorption ameliorates drug-resistant nephrotic syndrome due to focal glomerulosclerosis.
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Rapid improvement of hyperlipidemia by means of LDL-adsorption (LDL-A) was performed in seven steroidresistant nephrotic patients (4 males and 3 females; mean age 30.3 y.o., range 16 to 56 y.o.) with focal glomerulosclerosis (FGS) in order to ameliorate nephrotic syndrome (NS). LDL was adsorbed in a total of 4, 000ml of plasma in each LDL-A using a dextransulfate cellulose column (Liposorba LA-15). The duration of NS before LDL-A ranged from 1.5 to 26 months, and the total number of LDL-A treatment in each case ranged from 2 to 13. Treatment was successful in 4 cases who had complete or incomplete type I remission (improved cases, IC). The other 3 cases showed no significant improvements (resistant cases, RC). One of these progressed to endstage renal failure. The duration of NS before LDL-A in IC ranged from 1.5 to 4 months (mean 2.4 months) and was markedly shorter than those in RC, which ranged from 3 to 26 months (mean 13 months). There were no significant differences between these 2 groups in serum total cholesterol (TC) levels before LDL-A. The mean reduction ratios of TC in each treatment were almost identical. On the other hand, the time average concentrations (TAC) of TC during the period of LDL-A in IC ranged from 173 to 269mg/dl (mean 234.5mg/dl), and were lower than those in RC, which ranged from 280 to 342mg/dl (mean 297.2mg/dl). It was also noted that. LDL-A frequency was higher in the IC group. With regard to findings of immunofluorescent staining of apoprotein B (apo B) in renal biopsy specimens, the distribution of apo B in glomerular mesangium decreased in 2 of the 3 IC after LDL-A, in contrast with an increase in just the one RC who progressed to end-stage renal failure, and whose TAO of TO during LDL-A was the highest. It has been reported that 90% of FGS patients with NS resistant to conventional medication progress to renal failure. In our study, however, only one of the 5 cases progressed to renal failure; moreover, complete or incomplete type I remission with decreased glomerular lipid deposition was induced in 2 of these. These results indicate that rapid improvement of hyperlipidemia by LDL-A provides a possible therapy for steroid-resistant NS due to FGS.
- 社団法人 日本透析医学会の論文
社団法人 日本透析医学会 | 論文
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