Extracorporeal photochemotherapy for the treatment of glomerulopathies with associated nephrotic syndrome.

Patients with glomerulopathies associated with nephrotic syndrome have few effective treatment options. Here we report on the use of extracorporeal photochemotherapy (ECP) in 6 patients in whom glomerulopathy failed to respond to pharmacologic therapy. ECP is a promising immunomodulatory therapy associated with few side effects, that has been successfully used in the treatment of other immune-mediated conditions such as solid organ transplant rejection and graft-versus-host disease. METHODS: In this study, patients underwent 12 months of ECP. In all patients, progressive improvement in proteinuria was noted during the follow-up period, and total cholesterol and triglyceride levels also returned to near-normal values. RESULTS: In the 4 patients who had adequate renal function at study initiation, improvement of renal function was observed, as indicated by improved glomerular filtration rates (GFRs) and decreased proteinuria to creatininuria (Pru/Cru) ratios. In contrast, renal function progressively worsened in the 2 patients with inadequate renal function at study initiation. The results suggest that ECP is a feasible treatment for patients with glomerulopathies associated with nephrotic syndrome who have adequate baseline renal function. Additional clinical evaluation will have to be performed to better define the patient population in which ECP is most effective.