Kamijo Yuji, Kaneko Yoko, Ichikawa Toru, Kobayashi Nobuhiko, Koyama Takayuki, Kakegawa Tetsuji, Kamijo Hiroshi, Kono Keiichi, Minami Satoshi, Tanaka Naoki, Arakura Hideo, Hirata Masayuki, Higuchi Makoto, Kiyosawa Kendo, Hora Kazuhiko
Second Department of Internal Medicine, Shinsu University School of Medicine, Matsumoto, Nagano, Japan.
Ther Apher. 2002 Dec;6(6):459-62. doi: 10.1046/j.1526-0968.2002.00458.x.
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 cyclophosphamide, 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.
我们的报告讨论了一名29岁的女性患者，她因狼疮性肾炎患有肾病综合征，经活检证实为世界卫生组织分类的IVb型和V型，通过低密度脂蛋白（LDL）单采术得到控制。她最初接受了包括甲泼尼龙冲击疗法在内的类固醇治疗，其系统性红斑狼疮的血清学活性得到了抑制。然而，尽管进行了类固醇治疗，她的肾病状态以及严重的高脂血症仍持续存在。由于我们无法获得她同意使用环磷酰胺等免疫抑制剂，我们尝试使用LDL单采术（LDL-A）对她进行治疗。我们发现，开始LDL-A治疗后，她的尿蛋白排泄、高脂血症、低白蛋白血症和肾功能均有所改善。这表明，通过短期改善高脂血症，LDL-A可能是治疗狼疮性肾炎所致肾病综合征的有效疗法。
