Dextran sulphate cellulose columns for the treatment of nephrotic syndrome due to inactive lupus nephritis

Daimon, Shoichiro; Saga, Tsutomu; Nakayama, Miho; Nomura, Yumi; Chikaki, Hajime; Dan, Kazushi; Koni, Ichiro

doi:10.1093/ndt/15.2.235

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…Andresdottir et al . have reported a patient with type 1 MPGN who developed a recurrence of his disease after transplantation coinciding with a primary EBV infection [ 8 ]. Immunohistochemical examination of the biopsy of the transplant kidney for EBV viral capsid antigen demonstrated the presence of EBV in the cytoplasm of the glomerular podocytes.…”

Section: Discussionmentioning

confidence: 99%

Membranoproliferative glomerulonephritis associated with an Epstein-Barr virus infection

Karamadoukis¹,

Tóth

Tomson³

2008

Clinical Kidney Journal

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Type 1 membranoproliferative glomerulonephritis (MPGN) is an immune complex-mediated disorder that has been associated with certain viral infections including hepatitis C, hepatitis B, hepatitis G, HIV and Hantavirus. We describe a patient with type 1 MPGN in native kidneys and nephrotic syndrome in whom there was strong evidence that a primary Epstein–Barr virus (EBV) infection played a causative role. This patient was treated with an angiotensin 2-receptor blocker and the nephrotic syndrome resolved within 6 months from presentation. Our case report suggests that MPGN presenting with nephrotic syndrome may have a relatively benign course when it is associated with an acute EBV infection.

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Section: Discussionmentioning

confidence: 99%

Membranoproliferative glomerulonephritis associated with an Epstein-Barr virus infection

Karamadoukis¹,

Tóth

Tomson³

2008

Clinical Kidney Journal

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“…It has been reported that LDL‐A is an effective therapy for the treatment of patients with steroid‐resistant nephrotic syndrome (1–5). It removes LDL, very low‐density lipoprotein, and lipoprotein (a) using columns packed with a large number of dextran sulfate cellulose beads (6). Since dextran sulfate, which has negatively charged characteristics, has a high affinity to positively charged molecules and is able to bind to a number of molecules, including LDL, very low‐density lipoprotein, lipoprotein (a), anti‐DNA antibodies, anticardiolipin antibodies, and immune complex, it is utilized as the affinity ligand for LDL‐adsorbent and immunoadsorbent therapy (7,8).…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported recently that low‐density lipoprotein apheresis (LDL‐A) is an effective therapy for the treatment of some types of steroid‐resistant nephrotic syndrome due to focal glomerular sclerosis, minimal change nephrotic syndrome, and membranous nephropathy (1–5). However, with few reports on the subject, the effect of LDL‐A on lupus nephritis has not been clarified (6). In this report, we describe a case of nephrotic syndrome due to lupus nephritis which was controlled with LDL‐A through the short‐term amelioration of hyperlipidemia.…”

mentioning

confidence: 99%

A Case of Nephrotic Syndrome Due to Lupus Nephritis Which Was Controlled with Low‐Density Lipoprotein Apheresis

Kamijo¹,

Kaneko²,

Ichikawa³

et al. 2002

Therapeutic Apheresis

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Our report discusses a 29 year old female patient with nephrotic syndrome due to lupus nephritis, biopsy-proven World Health Organization classification Types IVb and V that was controlled with low-density lipoprotein (LDL) apheresis. She was initially treated with steroid therapy, including methylprednisolone pulse therapy, and the serological activity of her systemic lupus erythematosus was suppressed. However, her nephrotic state, accompanied by severe hyperlipidemia, persisted despite the steroid therapy. Since we could not obtain her consent to administer immunosuppressants such as cyclo-phosphamide, we tried to treat her using LDL apheresis (LDL-A). We found that her urine protein excretion, hyperlipidemia, hypoalbuminemia, and renal function improved following the initiation of LDL-A. This suggests that LDL-A may be an effective therapy for nephrotic syndrome due to lupus nephritis through short-term amelioration of hyperlipidemia.

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“…Due to its polyanionic structure, dextran sulphate also has a high affinity for antithrombin III, C3a, anticardiolipin antibodies, and anti‐ds‐DNA antibodies. By modifying pore size of the cellulose beads, the selectivity for adsorbing anti‐DNA antibodies is increased compared to LDL (44,45). An adsorption system has been developed using 2 dextran sulphate columns (Selesorb, Kanegafuchi) with a regenerating system avoiding saturation of columns.…”

Section: Adsorption Apheresismentioning

confidence: 99%

“…Although intrauterine growth retardation and fetal stress occurred, a baby was delivered by Caesarean section in the 34th gestational week. In a recent report (44), a patient with nephrotic syndrome due to inactive diffuse proliferative lupus nephritis was treated in a multimodal approach, including conventional LDL apheresis and treatment with anti‐DNA antibody absorber (Selesorb) as well as various immunosuppressive drugs. Reduction of proteinuria was recognized during immunoadsorption when anti‐DNA antibody titers were already decreased.…”

Section: Adsorption Apheresismentioning

confidence: 99%

Apheresis in Lupus Nephritis

Mistry‐Burchardi

Schönermarck

Samtleben

2001

Therapeutic Apheresis

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Systemic lupus erythematosus is a chronic autoimmune disease which commonly involves the kidneys. Despite great improvement in survival over the past years due to immunosuppressive therapy, renal failure remains an important cause of morbidity and mortality. In view of the pathogenesis of lupus nephritis, the use of less toxic and more specific ways of treatment such as the extracorporeal removal of pathogenetically relevant autoantibodies seems rational. On the basis of currently available studies, plasma exchange used alone or as an adjunct to conventional immunosuppressive therapy offers no clear benefit over standard immunosuppression in patients with active lupus nephritis and therefore cannot be recommended. However, although not proven, plasmapheresis might be beneficial in patients with acute life-threatening disease, for which high-dose immunosuppressive therapy may not be possible, or as an adjunct procedure for patients not responding to conventional therapy. Rather than the unselective removal of plasma, adsorption procedures allow the selective or specific removal of immunoglobulins, which seems to be a more reasonable approach in lupus nephritis. The results of the first clinical trials using different adsorption columns seem promising, but their use cannot be recommended until well-designed, casecontrolled studies have been performed to prove their usefulness and cost effectiveness in lupus nephritis. So far, clear-cut recommendations regarding type of adsorption column, intensity and duration of treatment, and accompanying immunosuppressive treatment cannot be given.

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Dextran sulphate cellulose columns for the treatment of nephrotic syndrome due to inactive lupus nephritis

Cited by 14 publications

References 18 publications

Membranoproliferative glomerulonephritis associated with an Epstein-Barr virus infection

Membranoproliferative glomerulonephritis associated with an Epstein-Barr virus infection

A Case of Nephrotic Syndrome Due to Lupus Nephritis Which Was Controlled with Low‐Density Lipoprotein Apheresis

Apheresis in Lupus Nephritis

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