Low-density lipoprotein apheresis therapy for steroid- and cyclosporine-resistant idiopathic membranous nephropathy.

We herein report three cases of Nephrotic Syndrome (NS) with idiopathic membranous nephropathy (IMN) in which the patients were resistant to steroid (PSL) and cyclosporine (CyA) therapy. All three patients had a high risk of renal failure because of persistently high levels of proteinuria. We performed low-density lipoprotein apheresis (LDL-A) and achieved complete remission in two cases. The third patients developed NS relapse and a deteriorating renal function; however, withdrawal from dialysis therapy was achieved. There are no proven therapies for treating patients with PSL- and CyA-resistant IMN with acute deteriorating renal function or difficulties in maintaining fluid balance. We evaluated the treatment course and physiological mechanisms and reviewed similar cases in the pertinent literature.