Abstract
We describe herein a patient with IgA nephropathy which first manifested clinically as steroid-resistant nephrotic syndrome. During the disease course acute renal failure occurred. Treatment with low density lipoprotein (LDL) apheresis resulted in remission of the nephrotic syndrome. The patient was a 45-year-old male who was admitted to our hospital because of marked hypoproteinemia and massive proteinuria. The patient was first treated, without effect, with steroids. Oliguria and azotemia progressed, and elevation of FENa was observed. The patient underwent 19 hemodialytic sets after which renal failure was controlled, and consequently the dialysis was discontinued. Renal biopsy revealed mild mesangial proliferative glomerulonephritis, and a study using the fluorescent antibody technique showed IgA deposition in the mesangium. Since the nephrotic syndrome persisted even after dialytic therapy, LDL apheresis was started. After a total of 12 sets of LDL apheresis, over a period of 3 months, his nephrotic syndrome was ameliorated. The renal performance at this time was judged to be type II incomplete remission. Acute renal failure rarely complicates IgA nephropathy even when the nephrotic syndrome develops during its course. At present, LDL apheresis is used mainly in the treatment of focal glomerulosclerosis (FGS). Our experience with LDL apheresis suggests that this therapeutic modality can also be useful for the treatment of nephrotic syndrome attributable to IgA nephropathy.
