微小変化群のネフローゼ症候群に合併した急性腎障害に血漿交換療法を併用した2例

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  • The beneficial effects of plasma exchange for treatment of acute kidney injury in minimal change nephrotic syndrome
  • ショウレイ ホウコク ビショウ ヘンカグン ノ ネフローゼ ショウコウグン ニ ガッペイ シタ キュウセイジンショウガイ ニ ケッショウ コウカン リョウホウ オ ヘイヨウ シタ 2レイ

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We report 2 cases of successful plasma exchange in patients with acute kidney injury in minimal change nephrotic syndrome. Case1 was a 39-year-old man and case2 was a 33-year-old woman. Both patients developed acute kidney injury in spite of methylprednisolone pulse therapy, and required hemodiafiltration. The serum albumin level in case1 was 1.8mg/dL and that in case2 was 1.6mg/dL. Albumin infusion was ineffective against acute kidney injury in both cases. Although hemodiafiltration was performed 3 times, it did not improve acute kidney injury in either case. Therefore, plasma exchange was performed using 5% albumin solution. At the end of plasma exchange, the urinary volume markedly increased, the renal function of the patients rapidly returned to the normal level, and further hemodiafiltration was not required. The pathological findings on renal biopsy showed typical minimal change disease with severe foot process effacement and without acute tubular necrosis in either case. Proteinuria began to improve 3 days after plasma exchange in case1 and after 1 day in case2. The renoprotective effects of plasma exchange cannot be ascribed to the correction of severe hypoalbuminemia. In addition, plasma exchange may involve the removal of unknown circulating pathogenic factors. The results suggested that plasma exchange might have a multiplier effect on the treatment of acute kidney injury in minimal change nephrotic syndrome when we attempted it after steroid therapy.

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