Low-Density Lipoprotein Apheresis Therapy for Steroid- and Cyclosporine-Resistant Idiopathic Membranous Nephropathy

Yoshinori Sato; Shinichiro Tsunoda; Tsuyoshi Nozue; Qinya Pan; Harue Wakasugi; Ashio Yoshimura

doi:10.2169/internalmedicine.51.7204

CASE REPORTS

Low-Density Lipoprotein Apheresis Therapy for Steroid- and Cyclosporine-Resistant Idiopathic Membranous Nephropathy

Yoshinori Sato, Shinichiro Tsunoda, Tsuyoshi Nozue, Qinya Pan, Harue Wakasugi, Ashio Yoshimura

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Keywords: LDL-apheresis, idiopathic membranous nephropathy (IMN), cyclosporine, nephrotic syndrome (NS)

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 18 Pages 2597-2602

DOI https://doi.org/10.2169/internalmedicine.51.7204

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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.

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