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Abstract: FR-PO1123

Effects of LDL-Apheresis in Adult Refractory Nephrotic Syndrome and Its Reproducibility

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Takizawa, Hideki, Teine Keijinkai Hospital, Sapporo, Japan
  • Shimamura, Yoshinosuke, Teine Keijinkai Hospital, Sapporo, Japan
  • Ogawa, Yayoi, Hokkaido Renal Pathology Center, Sapporo, Japan
Background

In 2018, Humanitarian device exemption allowed to utilize LDL-apheresis (LDL-A) for the treatment in adult patients with nephrotic-range focal segmental glomerulosclerosis (FSGS), but the efficacy is still uncertain. We performed case series of LDL-A in patients with refractory nephrotic syndrome, including FSGS, in a tertiary care center in Japan.

Methods

The efficacy of LDL-A was evaluated in 15 cases of refractory nephrotic syndrome (FSGS, n=4; minimal change disease (MCD), n=7; membranous nephropathy (MN), n=4) enrolled from April 2008 to April 2018. Demographic and clinical parameters were compared before and after performing LDL-A. Additionally, the efficacy of the second trial of LDL-A was evaluated in relapsed cases after the first trial of LDL-A.

Results

In 15 patients, all patients, except one, received immunosuppressive agents (prednisolone, 14; cyclosporine, 6; cyclophosphamide, 2), and there was no statistically significant reduction in proteinuria before initiating LDL-A (p=0.051; t-test). However, there were statistically significant reduction in proteinuria after performing the first trial of LDL-A in all groups (FSGS, 9.1 ± 1.9 g/day to 2.6 ± 1.0; MCD, 5.4 ± 1.4 to 0.4 ± 0.1; MN, 6.4 ± 0.5 to 2.3 ± 0.5; p <0.005; MANOVA). Multivariate analysis revealed the rate of remission was higher in MCD compared to other groups (R2=0.49, p<0.005). In relapsed cases after the first trial of LDL-A (n=7), the second trial of LDL-A was effective to reduce proteinuria, and there was no statistically difference in between the first trial and the second trial of LDL-A (First trial, 5.6 ± 1.1 to 0.7 ± 0.3; Second trial, 7.2 ± 1.5 to 0.8 ± 0.5, p=0.382; MANOVA).

Conclusion

This study suggested that LDL-A was effective for reducing proteinuria in patients with refractory nephrotic syndrome, and its effectiveness was reproducible. This may contributed to planning treatment strategies in these patients.