Treatment-resistant PLA2R-negative membranous nephropathy responsive to low-density lipoprotein apheresis

James M. Szymanski, Meryl Waldman, Cathy Conry-Cantilena, Kamille Aisha West

Research output: Contribution to journalArticlepeer-review

Abstract

Idiopathic membranous nephropathy is the most common cause of nephrotic syndrome in nondiabetic adults. The antibody most often implicated is the M-type phospholipase A2 receptor (PLA2R) antibody, found in >70% of primary membranous nephropathy cases. First-line therapy is immunosuppressive in nature, but for patients who are treatment-resistant there is a significant risk of end-stage renal disease and mortality. Hypercholesterolemia is not only a side effect of nephrotic syndrome, but also its presence may worsen renal function. A recent single-arm observational study in Japan found that low-density lipoprotein apheresis (LDL-A) was able to ameliorate nephrotic syndrome in half of patients who were resistant to medication. We present a case of treatment resistant PLA2R negative membranous nephropathy who had significant improvement following two courses of LDL-A. To our knowledge, this is the first such reported case in the United States.

Original languageEnglish (US)
Pages (from-to)495-498
Number of pages4
JournalJournal of Clinical Apheresis
Volume34
Issue number4
DOIs
StatePublished - Aug 2019
Externally publishedYes

Keywords

  • lipoprotein apheresis
  • membranous nephropathy
  • phospholipase A2

ASJC Scopus subject areas

  • Hematology

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