Immediate therapeutic efficacy of low-density lipoprotein apheresis for drug-resistant nephrotic syndrome: evidence from the short-term results from the POLARIS Study

被引：46

作者：

Muso, Eri ^{[1
]}

Mune, Masatoshi ^{[2
]}

Hirano, Tsutomu ^{[3
]}

Hattori, Motoshi ^{[4
]}

Kimura, Kenjiro ^{[5
]}

Watanabe, Tsuyoshi ^{[6
]}

Yokoyama, Hitoshi ^{[7
]}

Sato, Hiroshi ^{[8
]}

Uchida, Shunya ^{[9
]}

Wada, Takashi ^{[10
]}

Shoji, Tetsuo ^{[11
]}

Yuzawa, Yukio ^{[12
]}

Takemura, Tsukasa ^{[13
]}

Sugiyama, Satoshi ^{[14
]}

Nishizawa, Yoshiki ^{[11
]}

Ogahara, Satoru ^{[15
]}

Yorioka, Noriaki ^{[16
]}

Sakai, Soichi ^{[17
]}

Ogura, Yosuke ^{[17
]}

Yukawa, Susumu ^{[18
]}

Iino, Yasuhiko ^{[19
]}

Imai, Enyu ^{[20
]}

Matsuo, Seiichi ^{[21
]}

Saito, Takao ^{[22
]}

机构：

[1] Kitano Hosp, Tazuke Kofukai Med Inst, Div Nephrol & Dialysis, Kita Ku, Osaka 5308480, Japan

[2] Ryoshukai Takaishi Fujii Hosp, Takaishi, Japan

[3] Showa Univ, Sch Med, Dept Diabet Metab & Endocrinol, Tokyo 142, Japan

[4] Tokyo Womens Med Univ, Dept Pediat Nephrol, Tokyo, Japan

[5] St Marianna Univ, Sch Med, Dept Nephrol & Hypertens Internal Med, Kawasaki, Kanagawa, Japan

[6] Fukushima Med Univ, Sch Med, Dept Nephrol Hypertens Diabetol Endocrinol & Meta, Fukushima, Japan

[7] Kanazawa Med Univ, Sch Med, Div Nephrol, Uchinada, Ishikawa 92002, Japan

[8] Tohoku Univ, Grad Sch Pharmaceut Sci, Dept Clin Pharmacol & Therapeut, Sendai, Miyagi 980, Japan

[9] Teikyo Univ, Sch Med, Dept Internal Med, Tokyo 173, Japan

[10] Kanazawa Univ, Dept Lab Med, Grad Sch Med, Kanazawa, Ishikawa, Japan

[11] Osaka City Univ, Grad Sch Med, Dept Metab Endocrinol & Mol Med, Osaka 558, Japan

[12] Fujita Hlth Univ, Sch Med, Dept Nephrol, Toyoake, Aichi 47011, Japan

[13] Kinki Univ, Sch Med, Dept Pediat, Osaka, Japan

[14] Kanayama Clin, Div Nephrol, Nagoya, Aichi, Japan

[15] Fukuoka Univ, Div Nephrol & Rheumatol, Dept Internal Med, Fukuoka 81401, Japan

[16] Hiroshima Univ, Grad Sch Biomed Sci, Dept Adv Nephrol, Hiroshima, Japan

[17] Kidney Fdn, Tokyo, Japan

[18] Wakayama KD Clin, Wakayama, Japan

[19] Nippon Med Sch, Dept Nephrol, Tokyo 113, Japan

[20] Nakayamadera Imai Clin, Takarazuka, Hyogo, Japan

[21] Nagoya Univ, Dept Nephrol, Grad Sch Med, Nagoya, Aichi 4648601, Japan

[22] Fukuoka Univ, Gen Med Res Ctr, Fac Med, Fukuoka 81401, Japan

来源：

CLINICAL AND EXPERIMENTAL NEPHROLOGY | 2015年 / 19卷 / 03期

关键词：

Short-term results; Drug-resistant nephrotic syndrome; LDL apheresis; Lipid nephrotoxicity; LDL-APHERESIS; FOCAL GLOMERULOSCLEROSIS;

D O I：

10.1007/s10157-014-0996-8

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：

Hyperlipidemia is not merely a complication but a major exacerbating factor in longstanding nephrotic syndrome (NS). Low-density lipoprotein apheresis (LDL-A) has been reported to ameliorate dyslipidemia and induce rapid remission of NS. Several clinical studies have suggested the therapeutic efficacy of LDL-A, but the level of clinical evidence is insufficient. Therefore, a multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was initiated in Japan. Patients with drug-resistant NS were prospectively recruited into the study and treated with LDL-A in facilities that were registered in advance. In the POLARIS study design, the clinical data are to be followed up for 2 years. In the current study, we aimed at evaluating the short-term efficacy based on the treatment outcome of LDL-A immediately after completion of treatment. Along with rapid improvement of hyperlipidemia, LDL-A significantly improved proteinuria and hypoproteinemia after treatment. More than half of the patients showed remission of NS based on the urinary protein level at the completion of LDL-A. The duration of NS before the start of treatment was significantly shorter in patients who responded to LDL-A. An analysis of patients registered in the POLARIS study indicated that LDL-A has short-term efficacy for drug-resistant NS. Rapid relief of dyslipidemia by LDL-A may provide early remission in about half of the NS patients who are resistant to conventional medication. Completion of the POLARIS study may reveal additional long-term effects of LDL-A in these patients.

引用

页码：379 / 386

页数：8

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