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Low-Density Lipoprotein Apheresis in Patients with Acute Kidney Injury Due to Minimal Change Disease Requiring Acute Renal Replacement Therapy

Overview
Publisher Dove Medical Press
Specialty Nephrology
Date 2020 Jul 2
PMID 32606890
Citations 3
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Abstract

Low-density lipoprotein apheresis (LDL-A) has been developed as a therapy for familial hypercholesterolemia, but LDL-A has also been used as a general treatment for drug-resistant nephrotic syndrome (NS) due to focal segmental glomerulosclerosis (FSGS). The patients with NS due to minimal change disease (MCD) are often difficult to control effective circulating plasma volume, causes acute kidney injury (AKI), and when diuretics are not effective and the respiratory condition of patients worsens, patients require acute renal replacement therapy (ARRT). The effectiveness of LDL-A is not only reduction of serum low-density lipoprotein but also various other benefits. LDL-A might have improved renal hemodynamics by reducing vasoconstrictive eicosanoids and contributed to the therapeutic effect of antiproteinuric drugs such as corticosteroids. We treated a 49-year-old Japanese woman and a 71-year-old Japanese man with AKI caused by NS due to MCD, who required ARRT. Although these patients received ARRT and corticosteroids, their AKI and MCD did not improve sufficiently. We initiated LDL-A treatment for these patients as an additional treatment modality, because their total serum cholesterol levels were high at the time of admission. After the additional LDL-A treatment, both patients were able to discontinue ARRT, because NS and AKI in both patients were improved sufficiently. It is possible that early additional LDL-A is effective for patients with AKI and NS due to MCD who require ARRT, and may help patients discontinue ARRT because of the effect of LDL-A such as improving hypercoagulability and renal hemodynamics and contributing to the therapeutic effect of corticosteroids.

Citing Articles

An Elderly Case of Minimal Change Nephrotic Syndrome: Correlation between Renal Tubular Dysfunction and the Onset of Oliguric Acute Kidney Injury Requiring Hemodialysis.

Gojo M, Morimoto C, Taira S, Yasukawa M, Asakawa S, Nagura M Case Rep Nephrol. 2024; 2024:1505583.

PMID: 38716183 PMC: 11074827. DOI: 10.1155/2024/1505583.


Apheresis in Adult With Refractory Idiopathic Nephrotic Syndrome on Native Kidneys.

Moret L, Ganea A, Dao M, Hummel A, Knebelman B, Subra J Kidney Int Rep. 2021; 6(8):2134-2143.

PMID: 34386662 PMC: 8343786. DOI: 10.1016/j.ekir.2021.04.029.


Favorable therapeutic efficacy of low-density lipoprotein apheresis for nephrotic syndrome with impaired renal function.

Muso E, Sakai S, Ogura Y, Yukawa S, Nishizawa Y, Yorioka N Ther Apher Dial. 2021; 26(1):220-228.

PMID: 34057286 PMC: 9290660. DOI: 10.1111/1744-9987.13694.

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