Adding plasmapheresis to corticosteroids and alkylating agents: does it benefit patients with focal segmental...

Eleven adult patients with biopsy-proven primary FSGS and nephrotic syndrome resistant to steroids and cytotoxic drugs were treated with plasmapheresis in addition to oral prednisolone and intravenous cyclophosphamide. On the average each patient had undergone 17 sessions over a period of 15-25 weeks (mean 21.90+/-2.71 weeks).

One month after the last plasmapheresis session, 72.7% (n=8) of the patients were in clinical remission of nephrotic syndrome in association with the stabilization of renal function. In contrast, patients who did not respond 27.3% (n=3) had a gradual decline in renal function. After a mean follow-up of 27.45+/-6.31 months, six patients who responded (54.5%) remained in sustained complete or partial remission of proteinuria with stable renal function. The mean proteinuria at the latest examination was 0.9+/-0.01 g per day in these patients.

It is concluded that a combination of plasmapheresis, corticosteroids, and cyclophosphamide may obtain sustained improvement of proteinuria and stabilization of plasma creatinine in about half of the patients who proved to be refractory to therapy.