An update on LDL apheresis for nephrotic syndrome

Pediatr Nephrol. 2019 Oct;34(10):1655-1669. doi: 10.1007/s00467-018-4061-9. Epub 2018 Sep 14.

Abstract

Low-density lipoprotein (LDL) apheresis has been used increasingly in clinical practice for the treatment of renal diseases with nephrotic syndrome (NS), specifically focal segmental glomerulosclerosis (FSGS). Persistent hyperlipidemia for prolonged periods is nephrotoxic and leads to chronic progressive glomerular and tubulointerstitial injury. Effective management of hyperlipidemia with HMG-CoA reductase inhibitors or LDL apheresis in drug-resistant NS patients may prevent the progression of renal disease and, in some patients, resolution of NS symptoms. Available literature reveals beneficial effects of LDL apheresis for NS refractory to drug therapy. Here we update on the current understanding of lipid nephrotoxicity and application of LDL apheresis to prevent progression of renal diseases.

Keywords: Focal segmental glomerulosclerosis; Hyperlipidemia; Liposorber® LA-15 System; Low-density lipoprotein apheresis; Nephrotic syndrome; Podocyte injury.

Publication types

  • Review

MeSH terms

  • Animals
  • Blood Component Removal / methods*
  • Child
  • Disease Models, Animal
  • Disease Progression
  • Glomerulosclerosis, Focal Segmental / blood
  • Glomerulosclerosis, Focal Segmental / complications
  • Glomerulosclerosis, Focal Segmental / physiopathology
  • Glomerulosclerosis, Focal Segmental / therapy*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hyperlipidemias / blood
  • Hyperlipidemias / etiology
  • Hyperlipidemias / therapy*
  • Kidney Glomerulus / metabolism
  • Kidney Glomerulus / physiopathology
  • Lipid Metabolism
  • Lipoproteins, LDL / blood
  • Lipoproteins, LDL / metabolism*
  • Nephrotic Syndrome / blood
  • Nephrotic Syndrome / etiology
  • Nephrotic Syndrome / therapy*
  • Renal Elimination / physiology
  • Treatment Outcome

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoproteins, LDL