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2017 ; 18
(1
): 221
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Successful treatment of a patient with refractory nephrotic syndrome with PCSK9
inhibitors: a case report
#MMPMID28683788
Awanami Y
; Fukuda M
; Nonaka Y
; Takashima T
; Matsumoto K
; Yamasaki M
; Miyazono M
; Ikeda Y
BMC Nephrol
2017[Jul]; 18
(1
): 221
PMID28683788
show ga
BACKGROUND: The proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor
evolocumab is a low-density lipoprotein (LDL)-lowering drug with a new mechanism,
which is currently available in Japan. Here, for the first time, we report the
successful use of the PCSK9 inhibitor in a patient with refractory nephrotic
syndrome. CASE PRESENTATION: A 61-year-old woman was diagnosed with minimal
change-type nephrotic syndrome in October 2012. She received prednisolone (PSL)
and cyclosporin A (CyA), but she experienced several cycles of relapse and
remission and was hospitalized in May 2016 due to relapse. However, in spite of
steroid pulse therapy and adrenocorticotropic hormone (ACTH) administration, her
urinary protein level did not improve. We started her on evolocumab with the
expectation of equivalent LDL-lowering effects as seen with LDL apheresis. After
that, the LDL cholesterol level and UP/UC were concomitantly decreased, and the
serum albumin was increased. This was maintained even when we reduced the PSL
dose. This suggests that evolocumab clinically improves the nephrotic condition.
CONCLUSION: No other report has described the use of evolocumab for nephrotic
syndrome (NS) or its effect on similar nephrotic conditions. We believe that the
findings presented here are unique and may be beneficial when treating similar
cases.