Apheresis Therapy for Steroid-Resistant Idiopathic Nephrotic Syndrome: Report on a Case Series

Abstract

Idiopathic nephrotic syndrome (INS) represents 15%-30% of adulthood glomerulopathies. Corticosteroids have been the main treatment for decades and are effective in 70% of minimal-change disease patients and ~30% of focal segmental glomerulosclerosis patients. Multidrug-resistant (steroids, calcineurin-inhibitors, cyclophosphamide, mycophenolate-mofetil, rituximab) idiopathic nephrotic syndrome is a major therapeutic challenge in nephrology. Apheresis (double-filtration plasmapheresis or semi specific immunoadsorption) could act by eliminating the circulating factor (apolipoproteinA1b, solubleCD40L, suPAR) increasing glomerular permeability seen in INS. The aim of the study was to report the outcome of three patients with multidrug-resistant INS treated successfully with apheresis.

Figure 1

Outcome of albuminemia and albuminuria (g/L) for three patients. The blue arrow corresponds to the beginning of apheresis therapy and the red arrow corresponds to the stop of apheresis therapy. On the x axis are dates of the sessions and y axis on the left side albuminuria (g/L) and on the right side albuminemia (g/L).