LDL–apheresis in patients with nephrotic syndrome: effects on serum albumin and urinary albumin excretion

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公開日
2000-10-19
権利情報
  • http://onlinelibrary.wiley.com/termsAndConditions#vor
DOI
  • 10.1046/j.1365-2362.2000.00716.x
公開者
Wiley

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<jats:sec><jats:title>Background</jats:title><jats:p>Hyperlipidemia is a common feature of the nephrotic syndrome (NS). From retrospective studies, it has been suggested that aggressive lipid‐lowering with low‐density lipoprotein apheresis (LDL–A) may not only improve dyslipidemia but also decrease urinary albumin excretion and increase serum levels of albumin in patients with focal segmental sclerosis.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Seven patients (6 males) aged 44 ± 7 years (SEM) with NS (duration 29 ± 11 months) of diverse etiologies were investigated in a prospective study. A fixed protocol of LDL–A was designed for treatment twice‐a‐week for 3 weeks and then once a week for 7 weeks. The effects of LDL–A on lipid parameters (cholesterol, triglycerides, HDL, Lp(a), apo A‐I, apo B) and renal parameters (iohexol clearance, serum albumin and 24‐h urinary albumin excretion) were evaluated.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Following treatment by LDL–A a remission in the severity of the NS was observed in two patients whereas a clear improvement was observed in four of the patients. A small, but significant (<jats:italic>P</jats:italic> < 0.05), increase in serum albumin levels from 20 ± 2 to 24 ± 2 g L<jats:sup>−1</jats:sup> was noted after LDL–A. As expected, serum lipid parameters improved during LDL–A, and significant decreases in serum cholesterol, apo B and plasma Lp(a) were observed at different time‐points of LDL–A. Conversely, no significant changes in either triglyceride, HDL or apo A‐I levels were observed during LDL–A.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The present uncontrolled prospective study shows that LDL–A causes a rapid 30–40% decrease in serum cholesterol and plasma Lp(a) levels in patients with NS. The present prospective study also suggests that short‐term LDL–A treatment may increase serum albumin levels in nephrotic patients.</jats:p></jats:sec>

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