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Low-density lipoprotein apheresis in a patient with arteriosclerosis obliterans and light chain deposition disease

T Nakamura1, Y Kawagoe, T Matsuda

  • 1Department of Medicine, Shinmatsudo Central General Hospital, Chiba, Japan.

Clinical Nephrology
|July 1, 2004
PubMed

Insights

Low-density lipoprotein (LDL) apheresis improved kidney function, proteinuria, and skin ulcers in a patient with arteriosclerosis obliterans (ASO) and light chain deposition disease (LCDD). This treatment also enhanced circulation and reduced inflammatory markers.

Area of Science:

  • Nephrology
  • Cardiology
  • Immunology

Background:

  • Light chain deposition disease (LCDD) is a rare plasma cell dyscrasia characterized by the deposition of monoclonal immunoglobulin light chains in various organs, primarily the kidneys.
  • Arteriosclerosis obliterans (ASO) is a form of peripheral artery disease (PAD) caused by atherosclerosis, leading to reduced blood flow to the extremities.

Observation:

  • A 49-year-old female patient presented with renal dysfunction, nephrotic syndrome, and progressive skin ulcers on her left leg, secondary to arteriosclerosis obliterans (ASO) complicated with light chain deposition disease (LCDD).
  • Renal biopsy revealed diffuse mesangial nodular lesions and tubulointerstitial changes, with positive kappa light chain staining in glomeruli and tubular basement membranes.
  • Electron microscopy confirmed electron-dense deposits in the glomerular basement membrane, mesangium, and tubular basement membrane.

Findings:

  • Treatment with low-density lipoprotein (LDL) apheresis for 10 weeks led to significant improvements in serum lipid profiles, renal function markers (serum creatinine, blood urea nitrogen), and urinary protein excretion.
  • The patient experienced marked reduction in proteinuria, improvement in hypoalbuminemia, and amelioration of ischemic symptoms, including leg pain, coldness, and numbness.
  • Skin ulcers showed improvement, with increased skin temperature and enhanced walking distance, alongside favorable changes in plasma nitric oxide (NO) and endothelin (ET)-1 levels.

Implications:

  • LDL apheresis demonstrates therapeutic efficacy in managing hyperlipidemia, nephrotic syndrome, and renal dysfunction associated with LCDD.
  • This case highlights the potential of LDL apheresis in improving ischemic skin manifestations in patients with coexisting ASO and LCDD.
  • The study suggests that LDL apheresis may offer a beneficial treatment option for complex cases involving both renal and vascular complications.

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