LDL-apheresis and immunoadsorption: novel methods in the treatment of renal diseases refractory to conventional therapy

Plasma exchange was used for many years as the method of extracorporeal removal of antibodies and/or immune complexes that may be involved in the pathogenesis of renal diseases. Recently low-density lipoprotein (LDL)-apheresis and immunoadsorption were also introduced into nephrological practice. LDL-apheresis, designed originally as a rescue treatment for refractory hyperlipidaemia, appeared also to be effective in certain glomerulopathies, resistant to other treatment strategies. Similarly, immunoadsorption can be employed successfully in the treatment of different nephropathies, of both immunological and non-immunological pathogenesis. This method may also be effective as rescue treatment in some cases of acute rejection and recurrence of certain nephropathies after renal transplantation. The major advantage of both methods is their increased selectivity compared with standard plasma exchange. In addition, these techniques need no supplement fluid (namely fresh frozen plasma), which allows for markedly increased efficacy of the treatment as well as substantial reduction of infection risks.