Effect of protein A immunoadsorption in nephrotic syndrome of various etiologies

Protein A immunoadsorption (IA) has proved effective in reducing proteinuri a in patients with nephrotic syndrome after recurrence of focal and segment al glomerulosclerosis (FSGS) in kidney transplants. The effect of IA in nep hrotic syndrome of other etiologies remains unknown. Nine patients with nep hrotic syndrome secondary to membranous nephropathy (four cases), diabetes mellitus (one case), IgA nephropathy (two cases), and amyloidosis (two case s) had three to five TA of 2.5 plasma volumes over 4 to 8 d. Patients recei ved 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 LA. HemaCocrit 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 level s within 1 mo, as described in recurrent FSGS following transplantation. Wh en serum albumin balance was controlled by albumin infusion after LA in two patients, comparable decreases in proteinuria were observed. Therefore, LA is effective in producing short-term reduction of proteinuria In nephrotic syndromes related not only to FSGS but also to membranous and IgA nephropa thies, diabetes mellitus, and amyloidosis, which suggests that IA removes a nonspecific circulating hemodynamic-altering or permeability-increasing fa ctor.