| [ Summary ] |
In treatment of various renal diseases, the beneficial effect of apheresis has been suggested, even though most trials have not been conducted with appropriate protocols. Among those diseases, are thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS), for which plasmapheresis has been proven to be effective. In cases of Goodpasture's syndrome, the therapeutic value is limited to supplemental therapy for steroid and immunosuppressive agents. Furthermore, in TTP and HUS, plasmapheresis has been proven to be more effective in TTP than in HUS. Recent reports have showen that, in most cases of TTP, the autoantibodies, reacting to von Willebrand factor's cleaving enzyme, caused microembolisms; therefore. the removal of autoantibody and plasma infusion by plasmapheresis should improve TTP, at least on a theoretical basis.
In Japan, LDL-apheresis has been applied to patients with focal segmental nephrosclerosis, since it has been reported that LDL-cholesterol levels are an independent factor in the progression of this disorder. This trial shows an interesting alternative therapy for nephrotic syndrome, although the validity of LDL-apheresis should be further examined through controlled trial. |