Eri Muso1, Masatoshi Mune2, Tsutomu Hirano3, Motoshi Hattori4, Kenjiro Kimura5, Tsuyoshi Watanabe6, Hitoshi Yokoyama7, Hiroshi Sato8, Shunya Uchida9, Takashi Wada10, Tetsuo Shoji11, Yukio Yuzawa12, Tsukasa Takemura13, Satoshi Sugiyama14, Yoshiki Nishizawa11, Satoru Ogahara15, Noriaki Yorioka16, Soichi Sakai17, Yosuke Ogura17, Susumu Yukawa18, Yasuhiko Iino19, Enyu Imai20, Seiichi Matsuo21, Takao Saito22. 1. Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan. muso@kitano-hp.or.jp. 2. Ryoshukai Takaishi Fujii Hospital, Takaishi, Japan. 3. Department of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan. 4. Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan. 5. Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. 6. Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan. 7. Division of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan. 8. Department of Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan. 9. Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan. 10. Department of Laboratory Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan. 11. Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan. 12. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan. 13. Department of Pediatrics, Kinki University School of Medicine, Osaka-Sayama, Japan. 14. Division of Nephrology, Kanayama Clinic, Nagoya, Japan. 15. Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan. 16. Department of Advanced Nephrology, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan. 17. The Kidney Foundation, Japan, Tokyo, Japan. 18. Wakayama KD Clinic, Wakayama, Japan. 19. Department of Nephrology, Nippon Medical School, Tokyo, Japan. 20. Nakayamadera Imai Clinic, Takarazuka, Japan. 21. Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 22. Faculty of Medicine, General Medical Research Center, Fukuoka University, Fukuoka, Japan.
Abstract
BACKGROUND: Hyperlipidemia is not merely a complication but a major exacerbating factor in longstanding nephrotic syndrome (NS). Low-density lipoprotein apheresis (LDL-A) has been reported to ameliorate dyslipidemia and induce rapid remission of NS. Several clinical studies have suggested the therapeutic efficacy of LDL-A, but the level of clinical evidence is insufficient. Therefore, a multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was initiated in Japan. METHOD: Patients with drug-resistant NS were prospectively recruited into the study and treated with LDL-A in facilities that were registered in advance. In the POLARIS study design, the clinical data are to be followed up for 2 years. In the current study, we aimed at evaluating the short-term efficacy based on the treatment outcome of LDL-A immediately after completion of treatment. RESULTS: Along with rapid improvement of hyperlipidemia, LDL-A significantly improved proteinuria and hypoproteinemia after treatment. More than half of the patients showed remission of NS based on the urinary protein level at the completion of LDL-A. The duration of NS before the start of treatment was significantly shorter in patients who responded to LDL-A. CONCLUSIONS: An analysis of patients registered in the POLARIS study indicated that LDL-A has short-term efficacy for drug-resistant NS. Rapid relief of dyslipidemia by LDL-A may provide early remission in about half of the NS patients who are resistant to conventional medication. Completion of the POLARIS study may reveal additional long-term effects of LDL-A in these patients.
BACKGROUND:Hyperlipidemia is not merely a complication but a major exacerbating factor in longstanding nephrotic syndrome (NS). Low-density lipoprotein apheresis (LDL-A) has been reported to ameliorate dyslipidemia and induce rapid remission of NS. Several clinical studies have suggested the therapeutic efficacy of LDL-A, but the level of clinical evidence is insufficient. Therefore, a multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was initiated in Japan. METHOD:Patients with drug-resistant NS were prospectively recruited into the study and treated with LDL-A in facilities that were registered in advance. In the POLARIS study design, the clinical data are to be followed up for 2 years. In the current study, we aimed at evaluating the short-term efficacy based on the treatment outcome of LDL-A immediately after completion of treatment. RESULTS: Along with rapid improvement of hyperlipidemia, LDL-A significantly improved proteinuria and hypoproteinemia after treatment. More than half of the patients showed remission of NS based on the urinary protein level at the completion of LDL-A. The duration of NS before the start of treatment was significantly shorter in patients who responded to LDL-A. CONCLUSIONS: An analysis of patients registered in the POLARIS study indicated that LDL-A has short-term efficacy for drug-resistant NS. Rapid relief of dyslipidemia by LDL-A may provide early remission in about half of the NS patients who are resistant to conventional medication. Completion of the POLARIS study may reveal additional long-term effects of LDL-A in these patients.
Authors: K Yokoyama; S Sakai; T Sigematsu; F Takemoto; S Hara; A Yamada; Y Kawaguchi; T Hosoya Journal: Clin Nephrol Date: 1998-07 Impact factor: 0.975