Recurrent Primary XXXX Managed With Intensified Plasma Exchange and Concomitant Monitoring of Soluble Urokinase-Type Plasminogen Activator Receptor-Mediated Podocyte b3-integrin Activation.

@entity1 @entity644 @entity628 @entity8450 @entity454
BACKGROUND: Primary @entity628 ( @entity628 ) often causes nephrotic @entity644 and frequently results in @entity454 and recurrence after kidney transplantation. Recent studies describe soluble urokinase-type plasminogen activator receptor (suPAR) as a circulating factor implicated in @entity628 . METHODS: This single-center study included 12 adult @entity1 with histologically proven primary @entity628 (n = 2) or recurrent @entity628 after transplantation (n = 10). The effect of @entity8450 ( @entity8450 ) on clinical outcome, suPAR levels, and in vitro podocyte b3-integrin activation was investigated over a median of 11 (6-18) sessions of @entity8450 . RESULTS: The course of treatment was monitored in a total of 70 sessions of @entity8450 , which partly eliminated suPAR, with a mean reduction of 37    12% of serum concentration per session. However, a substantial rebound was observed between sessions, with suPAR levels reaching 99    22% of the pretreatment levels after a median of 4 days. Podocyte b3-integrin activation dropped significantly after @entity8450 but rebounded within 4 days concomitant with a rising suPAR level. In 11 of 12 @entity1 , multimodal treatment (including extensive @entity8450 ) reduced @entity644 significantly (from 5.3 [2.0-7.8] to 1.0 [0.4-1.6] g/d), indicating clinical efficacy of the therapy. One @entity1 suffered allograft loss due to @entity628 recurrence. A persisting response was independent of a lasting reduction in the level of total suPAR because there was no sustained significant change in suPAR levels before and after the course of intensified treatment (3814    908 to 3595    521 pg/mL; P = 0.496). CONCLUSIONS: We conclude that multimodal therapy including extensive @entity8450 was associated with stabilization of recurrent @entity628 and a temporary lowering of plasma suPAR as well as podocyte b3-integrin activation. Whether a sustained lowering of total suPAR results in further improved outcomes requires additional study.
