Early low-density lipoprotein apheresis for steroid-resistant minimal change disease with acute kidney injury: a case report.

Abstract

We report the case of a 75-year-old woman with steroid-resistant minimal change disease (MCD) whose refractory proteinuria and hypoproteinemia were controlled with early low-density lipoprotein apheresis (LDL-A). She was initially treated with steroid therapy, including methylprednisolone pulse. However, her hypoproteinemia, severe proteinuria, accompanied with renal insufficiency persisted despite these therapies. We initiated hemodialysis on day 17, and LDL-A on day 18. After the treatment, we found an improvement in her urine protein excretion, hyperlipidemia, and hypoproteinemia gradually. Her renal function returned to normal. We added cyclosporine A (CyA) after confirming the normal renal function. Her proteinuria was 0.693 g/day on day 350 and she achieved incomplete remission type I. There are few reports of the efficacy of LDL-A in older patients with MCD with acute kidney injury (AKI). In addition, there are only a few reports of cases in which LDL-A was introduced early, as in this case. This case suggests that early LDL-A may be an effective therapy for steroid-resistant MCD with AKI.