NDT Advance Access originally published online on October 7, 2008
Nephrology Dialysis Transplantation 2009 24(3):864-869; doi:10.1093/ndt/gfn555
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Successful treatment of patients with lipoprotein glomerulopathy by protein A immunoadsorption: a pilot study
Nanjing University Clinical School of Medicine, Research Institute of Nephrology, Jinling Hospital, Nanjing, People's Republic of China
Correspondence and offprint requests to: Li Leishi, Professor of Medicine, Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, People's Republic of China. Tel: +86-25-80860210; Fax: +86-25-84801992; E-mail: lilsh{at}cae.cn
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Abstract |
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Background. No established therapy is available for patients with lipoprotein glomerulopathy (LPG). Protein A immunoadsorption has been proved to be effective in reducing proteinuria in patients with nephrotic syndrome. In this uncontrolled pilot study, we investigated the efficiency of immunoadsorption onto staphylococcal protein A as treatment for LPG.
Methods. Thirteen patients with renal biopsy-proven LPG were treated with staphylococcal protein A immunoadsorption. Immunoadsorption was administered for 10 cycles per session and 10 sessions as a course. A total of 30 l of plasma was regenerated in each course.
Results. Single immunoadsorption course led to a rapid decline in proteinuria from 4.01 ± 3.09 g/24 h to 1.21 ± 0.97 g/24 h (mean ± SD) (n = 13, P = 0.001), along with a dramatic decline in apolipoprotein E (apo E) from 9.79 ± 5.04 mg/dl to 6.20 ± 2.22 mg/dl (P = 0.004). A repeated renal biopsy (n = 12) showed that intraglomerular lipoprotein thrombi almost disappeared. Six patients were enrolled in the investigation of long-term outcome, and proteinuria returned to baseline levels within 12 months. Four recurrent patients received repeat immunoadsorption treatment; proteinuria decreased from 5.02 ± 1.85 g/24 h to 1.64 ± 0.55 g/24 h at the end of the treatment, serum apo E decreased from 14.65 ± 11.17 mg/dl to 7.90 ± 1.72 mg/dl. No patients suffered from severe complications.
Conclusion. Our observations suggest that immunoadsorption onto protein A might be an effective treatment for resolving intraglomerular thrombi and improving nephrotic syndrome in patients with LPG. Further studies are required to define the influence of immunoadsorption on long-term effects in LPG patients.
Keywords: apolipoprotein E; immunoadsorption; lipoprotein glomerulopathy
Received for publication: 1. 6.08
Accepted in revised form: 11. 9.08