腎臓病におけるアフェレシス療法の進歩(<特集>アフェレシス療法における臨床評価方法について)

NDLデジタルコレクション
  • 北川,清樹
    独立行政法人国立病院機構金沢医療センター内科
  • 古市,賢吾
    金沢大学附属病院血液浄化療法部
  • 和田,隆志
    金沢大学大学院医薬保健学総合研究科血液情報統御学

書誌事項

タイトル別名
  • Progress of Apheresis for Renal Disease

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The effectiveness of apheresis has been reported in various renal diseases. In nephrotic syndrome, low-density lipoprotein (LDL) apheresis accompanied with conventional treatment improves proteinuria by reducing oxidized LDL and increasing the sensitivity of steroids and immunosuppressive agents. A nationwide prospective cohort study (Prospective Observational Survey on the Long-Term Effects of the LDL Apheresis on the Drug Resistant Nephrotic Syndrome : POLARIS) suggests that approximately 50% of patients with refractory nephrotic syndrome reached remission through LDL apheresis. Furthermore, an unidentified permeability factor (or factors) derived from lymphocytes would have a crucial role in nephrotic syndrome, especially for minimal change nephritic syndrome and focal segmental glomerulosclerosis. We have reported a series of effective cases of leukocytapheresis for nephrotic syndrome. Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome involving abrupt or insidious onset of hematuria, proteinuria, anemia and rapidly progressive renal failure. Anti-neutrophil cytoplasmic antibodies (ANCA) and anti-glomerular basement membrane (GBM) antibodies are thought to be involved in the clinical condition of RPGN. Treatment with immunosuppressive therapy plus plasma exchange, which directly removes ANCA or anti-GBM antibodies, has improved the outcome of patients with RPGN. Prospective studies in patients with ANCA-associated vasculitis and retrospective studies in patients with anti-GBM antibody-positive RPGN suggest the effectiveness of plasma exchange. Further studies will be needed to establish the effectiveness of apheresis for various renal diseases in greater depth.

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