Effect of Plasma Protein Adsorption on Protein Excretion in Kidney-Transplant Recipients with Recurrent Nephrotic Syndrome

Abstract

Adsorption of plasma protein decreases urinary protein excretion in patients with recurrence of the nephrotic syndrome after renal transplantation. Studies of the adsorbed proteins should provide information about the mechanism of this disease.

Advances in apheresis therapy for glomerular diseases

“…Seven patients, including all 4 with first grafts and 3 of 6 with prior recurrence, were free of recurrence at follow-up (238-1258 days) [29]. Dantal et al reported the active factor binds to protein A in FSGS, which was speculated as immunoglobulins, immunoglobulin fragments or proteins binding to Fc chains such as complement components, transforming growth factor-or other Ig-binding proteins [6,8]. Bosch and Wendler [30] summarized recent studies provide evidence that patients with recurrent FSGS after renal transplantation and those of primary FSGS can profit from PE or immunoadsorption.…”

“…Finally, complete or partial remission (proteinuria <1.0 g/day) was seen in patients treated by LCAP and following immunosuppressive or supportive therapy. In the results of LCAP [12], the serum levels of immunoglobulins, complements or lipids only changed in a small part even in the response group, suggesting that the mechanism of LCAP may be different from those of plasma protein adsorption using Protein A sepharose cartridges [6][7], anti-human immunoglobulin affinity immunadsorption [7][8], or LDL apheresis [11] as previously described. However, impaired size barrier of the glomerular capillary walls causing the increased glomerular protein permeability could not be improved by LCAP [12].…”

“…Circulating glomerular albumin permeability factor(s) were also detected in patients with native (primary) focal segmental glomerulosclerosis (FSGS) and recurrent FSGS after renal transplantation [4][5]. In such cases, plasma protein adsorption using Protein A sepharose cartridges [6][7] or anti-human immunoglobulin affinity immunoadsorption [7][8], plasma exchange (PE) [9][10], LDL apheresis [11] and/or LCAP [12] have been reported to be effective even for steroid-cyclosporin-A (CyA) resistant cases through removing the glomerular permeability factor(s) in some of these nephrotic patients. In this review, we overviewed the immunomodulation effects and clinical evidence of apheresis in various glomerular diseases, especially nephrotic syndrome and severe nephritic syndrome.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…Indeed, the risk of recurrence when there has been a previous allograft failure due to recurrent FSGS may be as high as 80% (274,282,286,291). It has been shown by some investigators that the presence of an abnormal serum protein correlates with FSGS recurrence (286,292,293). However, standardized assays are not available for clinical use.…”

Nephrotic syndrome and rituximab: facts and perspectives

“…it is an immunoglobulin) or secondary to an aberrant cross-talk between T-and B-cells. These hypotheses are supported by (1) the recurrence of nephrotic syndrome after renal transplantation, (2) the reduction in the total B-cell count during remission of nephrotic syndrome, and (3) remission of the disease by depletion of B-cells [7][8][9][10]. The latter can be achieved through administration of the chimeric monoclonal antibody rituximab (RTX), which inhibits CD20-mediated Bcell proliferation and differentiation.…”