Sato Yoshinori, Tsunoda Shinichiro, Nozue Tsuyoshi, Pan Qinya, Wakasugi Harue, Yoshimura Ashio
Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan.
Intern Med. 2012;51(18):2597-602. doi: 10.2169/internalmedicine.51.7204. Epub 2012 Sep 15.
We herein report three cases of Nephrotic Syndrome (NS) with idiopathic membranous nephropathy (IMN) in which the patients were resistant to steroid (PSL) and cyclosporine (CyA) therapy. All three patients had a high risk of renal failure because of persistently high levels of proteinuria. We performed low-density lipoprotein apheresis (LDL-A) and achieved complete remission in two cases. The third patients developed NS relapse and a deteriorating renal function; however, withdrawal from dialysis therapy was achieved. There are no proven therapies for treating patients with PSL- and CyA-resistant IMN with acute deteriorating renal function or difficulties in maintaining fluid balance. We evaluated the treatment course and physiological mechanisms and reviewed similar cases in the pertinent literature.
我们在此报告三例患有特发性膜性肾病（IMN）的肾病综合征（NS）患者，这些患者对类固醇（PSL）和环孢素（CyA）治疗耐药。由于蛋白尿水平持续居高不下，所有三名患者都有肾衰竭的高风险。我们进行了低密度脂蛋白去除术（LDL-A），两例患者实现了完全缓解。第三名患者出现了NS复发且肾功能恶化；然而，最终成功停止了透析治疗。对于PSL和CyA耐药的IMN且伴有急性肾功能恶化或维持液体平衡困难的患者，目前尚无经证实的治疗方法。我们评估了治疗过程和生理机制，并查阅了相关文献中的类似病例。
