Plasmapheresis in the treatment of steroid-resistant focal segmental glomerulosclerosis in native kidneys

被引:89
作者
Feld, SM
Figueroa, P
Savin, V
Nast, CC
Sharma, R
Sharma, M
Hirschberg, R
Adler, SG
机构
[1] Harbor UCLA Med Ctr, Torrance, CA 90509 USA
[2] Med Coll Wisconsin, Milwaukee, WI 53226 USA
[3] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
关键词
focal segmental glomerulosclerosis; plasmapheresis; glomerular capillary albumin permeability;
D O I
10.1053/ajkd.1998.v32.pm9708606
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
A circulating glomerular capillary albumin permeability factor (P-alb) has been implicated in the pathogenesis of focal segmental glomerulosclerosis (FSGS), which recurs in transplanted kidneys. Plasmapheresis for recurrent FSGS may reduce proteinuria and stabilize renal function if instituted early. We performed six plasmapheresis treatments over 2 weeks in eight patients with a history of steroid-resistant idiopathic FSGS in native kidneys for an average of 12 +/- 2.3 months to determine whether treatment would decrease proteinuria or stabilize renal function. P-alb was measured before and after plasmapheresis, and patients were followed-up for a mean of 29 +/- 4 months after the development of clinical symptoms. Proteinuria decreased in two of eight treated patients, although only transiently in one of the two. P-alb improved in one of the two responding patients. Both patients with an improvement in proteinuria had stable renal function at last follow-up. In six of eight patients, there was no improvement in proteinuria despite an improvement in P-alb (P < 0.0001) after plasmapheresis. At last follow-up, real function was stable in two of the six nonresponding patients, and four of the six had significant progression of renal disease or were receiving dialysis treatments, These studies suggest that plasmapheresis may diminish proteinuria and stabilize renal function in a small minority of patients with steroid-resistant idiopathic FSGS. However, the lack of a relationship between the removal of the circulating permeability factor and the development of remission in these patients suggests that local factors associated with advanced renal injury or systemic factors unrelated to glomerular permeability play a significant role in determining proteinuria at this late stage of the disease. (C) 1998 by the National Kidney Foundation, Inc.
引用
收藏
页码:230 / 237
页数:8
相关论文
共 20 条
[1]   RECURRENT FOCAL GLOMERULOSCLEROSIS - NATURAL-HISTORY AND RESPONSE TO THERAPY [J].
ARTERO, M ;
BIAVA, C ;
AMEND, W ;
TOMLANOVICH, S ;
VINCENTI, F .
AMERICAN JOURNAL OF MEDICINE, 1992, 92 (04) :375-383
[2]   PLASMAPHERESIS REDUCES PROTEINURIA AND SERUM CAPACITY TO INJURE GLOMERULI IN PATIENTS WITH RECURRENT FOCAL GLOMERULOSCLEROSIS [J].
ARTERO, ML ;
SHARMA, R ;
SAVIN, VJ ;
VINCENTI, F .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1994, 23 (04) :574-581
[3]  
BAKKER WW, 1986, KIDNEY INT, V30, P633
[4]   RECURRENT NEPHROTIC SYNDROME AFTER TRANSPLANTATION - EARLY TREATMENT WITH PLASMAPHAERESIS AND CYCLOPHOSPHAMIDE [J].
COCHAT, P ;
KASSIR, A ;
COLON, S ;
GLASTRE, C ;
TOURNIAIRE, B ;
PARCHOUX, B ;
MARTIN, X ;
DAVID, L .
PEDIATRIC NEPHROLOGY, 1993, 7 (01) :50-54
[5]   THE MANY MASKS OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS [J].
DAGATI, V .
KIDNEY INTERNATIONAL, 1994, 46 (04) :1223-1241
[6]   EFFECT OF PLASMA-PROTEIN ADSORPTION ON PROTEIN EXCRETION IN KIDNEY-TRANSPLANT RECIPIENTS WITH RECURRENT NEPHROTIC SYNDROME [J].
DANTAL, J ;
BIGOT, E ;
BOGERS, W ;
TESTA, A ;
KRIAA, F ;
JACQUES, Y ;
DELIGNY, BH ;
NIAUDET, P ;
CHARPENTIER, B ;
SOULILLOU, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 330 (01) :7-14
[7]  
Glassock RJ, 1996, The kidney
[8]   INCREASING INCIDENCE OF FOCAL-SEGMENTAL GLOMERULOSCLEROSIS AMONG ADULT NEPHROPATHIES - A 20-YEAR RENAL BIOPSY STUDY [J].
HAAS, M ;
SPARGO, BH ;
COVENTRY, S .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1995, 26 (05) :740-750
[9]   A GLOMERULAR-PERMEABILITY FACTOR PRODUCED BY HUMAN T-CELL HYBRIDOMAS [J].
KOYAMA, A ;
FUJISAKI, M ;
KOBAYASHI, M ;
IGARASHI, M ;
NARITA, M .
KIDNEY INTERNATIONAL, 1991, 40 (03) :453-460
[10]   PLASMA-EXCHANGE FOR RECURRENT NEPHROTIC SYNDROME FOLLOWING RENAL-TRANSPLANTATION [J].
LAUFER, J ;
ETTENGER, RB ;
HO, WG ;
COHEN, AH ;
MARIK, JL ;
FINE, RN .
TRANSPLANTATION, 1988, 46 (04) :540-542