ステロイド抵抗性ネフローゼ症候群に対するLDL-アフェレーシスの有用性に関する検討

抄録

Eight courses of LDL-apheresis (LDL-A) with the liposorber LA-15 system (Kaneka, Osaka, Japan) were analyzed in 6 patients with steroid-resistant nephrotic syndrome. Of the 8 courses of LDL-A, 5 were administered to treat focal glomerular sclerosis and 3 for minimal-change type nephrotic syndrome in 4 male and 4 female patients. The patients averaged 46.1 ± 12.4 years in age at the time of LDL-A. LDL-A treatment consisted of about 4, 000 ml of blood plasma over 2-3 hours, and was performed l-3 times per week and 9-12 times (average : 11.6) per course. Before and after a course of LDL-A, 24 hour urine protein, creatinine clearance (CCr), biochemistry tests, and coagulation tests (thrombin-anti thrombin III complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and β-thromboglobulin (β-TG) ) were performed. Of the 8 courses, 4 achieved a complete remission, and one achieved a type I incomplete remission (response group) . Two patients receiving the other three courses eventually required hemodialysis (nonresponse group) . In the response group, LDL-A was administered for an average of 3.8±2.0 months after the disease onset. This interval was significantly shorter than that of 23.3 ± 10.3 months in the non response group(p = 0.005) . Before LDL-A, TAT was 38.0 ± 19.1 and 7.6±2.1ng/ml in the response and non-response groups, respectively, showing a significant difference (p = 0.037) . In the response group, CCr was 37.0±5.0 ml/min before LDL-A, and increased significantly to 55.7 ± 12.0ml/ min after LDL-A (p = 0.038) . The disease did not recur in the response group after an average of 37 months of follow-up. These results indicate that LDL-A should be performed as early as possible after the onset of nephrotic syndrome, and that before LDL-A, TAT was high in the response group.