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J Am Soc Nephrol 10:2014-2017, 1999
© 1999 American Society of Nephrology

BRIEF COMMUNICATION

Effect of Protein A Immunoadsorption in Nephrotic Syndrome of Various Etiologies

VINCENT L. M. ESNAULT*, DOMINIQUE BESNIER*, ANGELO TESTA*, PIERRE COVILLE{ddagger}, PIERRE SIMON§, JEAN-FRANÇOIS SUBRA|| and MARIE A. P. AUDRAIN{dagger}

* Nephrology-Clinical Immunology Department Nantes University Hospital, France
{dagger} Laboratory of Immunopathology, Nantes University Hospital, France
{ddagger} Nephrology Department of Vannes, France
§ Nephrology Department of Saint-Brieuc, France
|| Nephrology Department of Angers, France.

Correspondence to Dr. Vincent.L. M. Esnault, Néphrologie-Immunologie Clinique, Hôtel Dieu, 30 bd. Jean Monnet, 44093 Nantes, France. Phone: +33 24008 7454; Fax: +33 24008 7436; E-mail: vesnault{at}nantes.inserm.fr

Abstract

Abstract. Protein A immunoadsorption (IA) has proved effective in reducing proteinuria in patients with nephrotic syndrome after recurrence of focal and segmental glomerulosclerosis (FSGS) in kidney transplants. The effect of IA in nephrotic syndrome of other etiologies remains unknown. Nine patients with nephrotic syndrome secondary to membranous nephropathy (four cases), diabetes mellitus (one case), IgA nephropathy (two cases), and amyloidosis (two cases) had three to five IA of 2.5 plasma volumes over 4 to 8 d. Patients received no concomitant immunosuppressive treatment, and antihypertensive drugs were left unchanged. Proteinuria decreased from 12.64 ± 5.49 to 3.35 ± 2.2 g/24 h (mean ± SD) in all patients after three to five IA. Hematocrit decreased from 37.32 to 32.64% (12.5% hemodilution) and serum albumin from 25.43 to 18.6 g/L (26.4% decrease). Proteinuria returned to baseline levels within 1 mo, as described in recurrent FSGS following transplantation. When serum albumin balance was controlled by albumin infusion after IA in two patients, comparable decreases in proteinuria were observed. Therefore, IA is effective in producing short-term reduction of proteinuria in nephrotic syndromes related not only to FSGS but also to membranous and IgA nephropathies, diabetes mellitus, and amyloidosis, which suggests that IA removes a nonspecific circulating hemodynamic-altering or permeability-increasing factor.




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