Kidney Week

Abstract: SA-PO0813

Successful LDL-Apheresis Treatment in Native Kidney Steroid-Resistant Nephrotic Syndrome

Session Information

• Glomerular Management: Real-World Lessons and Emerging Therapies
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Lagas, Maxwell Silver, Loma Linda University Health, Loma Linda, California, United States

Maxwell Silver Lagas, MD

• Nayak, Anjali B., Phoenix Children's Hospital, Phoenix, Arizona, United States

Anjali B. Nayak, MD

• Sanchez-Kazi, Cheryl P., Loma Linda University Health, Loma Linda, California, United States

Cheryl P. Sanchez-Kazi, MD, FASN

• Zaritsky, Joshua, Phoenix Children's Hospital, Phoenix, Arizona, United States

Joshua Zaritsky, MD, PhD, FASN

Background

Nephrotic syndrome is the most common glomerular disease seen in pediatric populations. Children who do not achieve partial or complete remission with steroids and other second line agents have a 50% risk of ESKD within 5 years. LA-15^TM LDL apheresis is an extracorporeal lipoprotein apheresis machine that is now approved by the FDA for post-transplant recurrence steroid resistant nephrotic syndrome. There is not much data on its use in pre-transplant. We describe eight patients on LDL-Apheresis with multi-drug-resistant nephrotic syndrome in their native kidneys.

Methods

This was a retrospective multi-center study. There were eight patients evaluated, and all had failed multi-drug therapy in their native kidneys. There were variable number of LDL-apheresis treatments, but all had at least 12 treatments with the standard course over at least 9 weeks with IV methylprednisolone for the last 6 treatments (Fig 1).

Results

Primary outcomes were measured by remission for nephrotic syndrome as defined as urine protein:creatinine ratios (UP/CR) at 0.2 (g/dL) or greater than or equal to a 50% reduction in the UP/CR. Secondary outcomes included improvement in serum albumin. Seven of eight patients entered complete remission with improvement in serum albumin by the end of treatment of LDL-Apheresis. Patient 3 did not change (Fig 2). Seven of eight patients stayed in complete remission one-year post-treatment except patient 2 who had relapse of disease (Fig 2).

Conclusion

LDL-Apheresis should be considered in patients with native kidney steroid resistant nephrotic syndrome not just post-transplant recurrence. Future studies still need to be done to determine mechanism of action. LDL-Apheresis is a well-tolerated treatment that can be used for transplant recurrence and native kidney nephrotic syndrome.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025kkxyg927