Resolution of typical lipoprotein glomerulopathy by intensive lipid-lowering therapy
Abstract
Lipoprotein glomerulopathy (LPG), characterized by glomerular lipoprotein thrombi, presumably composed of abnormal apolipoprotein E (apoE), leads to a progressive decline in renal function and eventually results in end-stage renal failure. A successful treatment for LPG has not yet been established. The authors treated a 36-year-old woman with LPG and exhibiting a nephrotic syndrome using an intensive lipid-lowering therapy consisting of fenofibrate (300 mg), niceritrol (750 mg), ethyl-icosapentate (1,800 mg), and probucol (500 mg). After the start of treatment, a remarkable decrease in urinary protein excretion and improvement in the hyperlipidemia were obtained; proteinuria was no longer detected 11 months after the initiation of treatment. A second biopsy performed 11 months after the initiation of treatment showed the complete disappearance of the lipoprotein thrombi that had been observed in a diffuse and global manner in the first renal biopsy. These findings suggest that typical LPG could be regressed if the abnormal lipoproteinemia is controlled sufficiently.
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Fibrates and ACEI/ARB may be effective for LPG remission.
“Though no effective treatment has been established, fibrates and ACEI/ARB may be effective for LPG remission (Arai et al., 2003; Ieiri, Hotta, & Taguma, 2003; Matsunaga et al., 2009).”
From Clinical and genetic analysis of lipoprotein glomerulopathy patients caused by <i>APOE</i> mutations (2020) · cites this paper as Ieiri, Hotta, & Taguma, 2003
Worldwide, only 22 cases of LPG including this case have reported the results of more than one native kidney biopsy.
“Worldwide, only 22 cases of LPG including this case have reported the results of more than one native kidney biopsy.14,15,29,32,44–49”
From Lipoprotein Glomerulopathy, First Case Report from Canada (2022) · cites this paper as [46]
Previous case reports found combined treatment with glucocorticoids and immunosuppressants ineffective; intensified treatment with lipid-lowering drugs including fibrates provided clinical and histological relief, with serum cholesterol, triglycerides, and ApoE decreased, and consecutive renal biopsies demonstrated complete disappearance of lipoprotein thrombi.
“Previous case reports that found combined treatment with glucocorticoids and immunosuppressants ineffective used intensified treatment with lipid-lowering drugs (including fibrates) to provide clinical and histological relief for patients. In those cases, serum cholesterol, triglycerides, and ApoE decreased, and consecutive renal biopsies demonstrated complete disappearance of lipoprotein thrombi.”
From A boy and his mother with lipoprotein glomerulopathy: Two case reports and literature review (2025) · cites this paper as [32]
Cites
Lipoprotein Glomerulopathy: Glomerular Lipoprotein Thrombi in a Patient With Hyperlipoproteinemia
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Apolipoprotein E–related glomerular disorders
Saito, T., Matsunaga, A., Fukunaga, M., Nagahama, K., Hara, S., & Muso, E. (2020) · Kidney International · doi:10.1016/j.kint.2019.10.031 · Cited by 77 · see citing works
Tsimihodimos, V., & Elisaf, M. (2011) · Current Opinion in Lipidology · doi:10.1097/mol.0b013e328345ebb0 · Cited by 33 · see citing works
A founder haplotype of APOE-Sendai mutation associated with lipoprotein glomerulopathy
Toyota, K., Hashimoto, T., Ogino, D., Matsunaga, A., Ito, M., Masakane, I., Degawa, N., Sato, H., Shirai, S., Umetsu, K., et al. (2013) · Journal of Human Genetics · doi:10.1038/jhg.2013.8 · Cited by 19 · see citing works
Clinical and genetic analysis of lipoprotein glomerulopathy patients caused by <i>APOE</i> mutations
Yang, M., Weng, Q., Pan, X., Hussain, H. M. J., Yu, S., Xu, J., Yu, X., Liu, Y., Jin, Y., Zhang, C., et al. (2020) · Molecular Genetics & Genomic Medicine · doi:10.1002/mgg3.1281 · Cited by 15 · see citing works
Common Apolipoprotein E Gene Mutations Contribute to Lipoprotein Glomerulopathy in China
Han, J., Pan, Y., Chen, Y., Li, X., Xing, G., Shi, J., Hou, P., Zhang, H., & Wang, H. (2010) · Nephron Clinical Practice · doi:10.1159/000276578 · Cited by 13 · see citing works
Clinicopathological and genetic characteristics in Chinese patients with lipoprotein glomerulopathy
Zhang, B., Liu, Z.-H., Zeng, C.-H., Zheng, J.-M., Chen, H.-P., & Li, L.-S. (2008) · Journal of Nephrology · doi:10.1093/joneph/21.1.110 · Cited by 12 · see citing works
Lipoprotein Glomerulopathy, First Case Report from Canada
Ting, J. A., McRae, S. A., Schwartz, D., Barbour, S. J., & Riazy, M. (2022) · International Journal of Nephrology and Renovascular Disease · doi:10.2147/ijnrd.s364890 · Cited by 7 · see citing works
A boy and his mother with lipoprotein glomerulopathy: Two case reports and literature review
Zhang, S., Fan, L., Li, Z., Liu, T., Jing, X., & Guo, Q. (2025) · Medicine · doi:10.1097/md.0000000000041628 · Cited by 2 · see citing works
- Authors
- Ieiri, N., Hotta, O., & Taguma, Y.
- Affiliations
- Sendai Shakai Hoken Hospital (JP)
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2003-01
- Volume
- 41
- Issue
- 1
- Pages
- 244-249
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2035836385
- Cited by
- 50
- References
- 1
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 2 · 2020: 1 · 2019: 3 · 2018: 3 · 2016: 3 · 2014: 1 · 2013: 5 · 2012: 3
- FWCI
- 0.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- lipoprotein glomerulopathy, lipid-lowering therapy, fenofibrate, probucol, nephrotic syndrome, proteinuria, hyperlipidemia, apolipoprotein E, renal biopsy
- MeSH terms
- Adult, Anticholesteremic Agents, Hypolipidemic Agents, Apolipoproteins E, Drug Combinations, Female, Humans, Kidney Diseases, Kidney Glomerulus, Lipids, Lipoproteins, Male, Microscopy, Electron, Nephrotic Syndrome, Niceritrol, Pedigree, Probucol, Fenofibrate, Eicosapentaenoic Acid
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