Low-density lipoprotein apheresis (
LDL-A) has been developed as a
therapy for
familial hypercholesterolemia, but
LDL-A has also been used as a general treatment for
drug-resistant
nephrotic syndrome (NS) due to
focal segmental glomerulosclerosis (FSGS). The patients with NS due to
minimal change disease (MCD) are often difficult to control effective circulating plasma volume, causes
acute kidney injury (AKI), and when
diuretics are not effective and the respiratory condition of patients worsens, patients require acute
renal replacement therapy (ARRT). The effectiveness of
LDL-A is not only reduction of serum
low-density lipoprotein but also various other benefits.
LDL-A might have improved renal hemodynamics by reducing vasoconstrictive
eicosanoids and contributed to the
therapeutic effect of antiproteinuric drugs such as
corticosteroids. We treated a 49-year-old Japanese woman and a 71-year-old Japanese man with AKI caused by NS due to MCD, who required ARRT. Although these patients received ARRT and
corticosteroids, their AKI and MCD did not improve sufficiently. We initiated
LDL-A treatment for these patients as an additional treatment modality, because their total serum
cholesterol levels were high at the time of admission. After the additional
LDL-A treatment, both patients were able to discontinue ARRT, because NS and AKI in both patients were improved sufficiently. It is possible that early additional
LDL-A is effective for patients with AKI and NS due to MCD who require ARRT, and may help patients discontinue ARRT because of the effect of
LDL-A such as improving
hypercoagulability and renal hemodynamics and contributing to the
therapeutic effect of
corticosteroids.