Lipoprotein glomerulopathy treated with LDL-apheresis (Heparin-induced Extracorporeal Lipoprotein Precipitation system): a case report
Open accessAbstract
INTRODUCTION: Lipoprotein glomerulopathy is a glomerulonephritis which was described for the first time by Saito in 1989 and is currently acknowledged as a separate nosological entity. It is histologically characterized by a marked dilatation of the glomerular capillaries and the presence of lipoprotein thrombi in the glomerular lumens. The dyslipidemic profile is similar to that of type III dyslipoproteinemia with Apolipoprotein E values that are often high; proteinuria and renal dysfunction are present. Proteinuria often does not respond to steroid and cytostatic treatments. The phenotypic expression of lipoprotein glomerulopathy is most probably correlated to a genetic alteration of the lipoprotein metabolism (mutation of the Apolipoprotein E coding gene). In literature, lipoprotein glomerulopathies have mainly been reported in Japanese and Chinese subjects, except for three cases in the Caucasian race, reported in France and the USA. CASE PRESENTATION: We describe the case of a 60-year-old female, Caucasian patient suffering from lipoprotein glomerulopathy, carrier of a new mutation on the Apolipoprotein E gene (Apolipoprotein E(MODENA)), and treated successfully with low density lipoprotein-apheresis with the Heparin induced extracorporeal lipoprotein precipitation system. After a first phase of therapeutic protocol with statins, the patient was admitted for nephrotic syndrome, renal failure and hypertension. Since conventional treatment alone was not able to control dyslipidemia, aphaeretic treatment with heparin-induced Extracorporeal Lipoprotein Precipitation - apheresis (HELP-apheresis) was started to maintain angiotensin converting enzyme inhibitor therapy for the treatment of hypertension. Treatment with HELP-apheresis led to a complete remission of the proteinuria in a very short time (four months), as well as control of hypercholesterolemia and renal function recovery. CONCLUSION: According to this case of lipoprotein glomerulopathy, we believe that renal damage expressed by proteinuria correlates to the levels of lipids and, furthermore, the treatment with HELP-apheresis, by lowering low-density lipoprotein cholesterol and triglycerides, may be considered as a therapeutic option in synergy with pharmacological treatment in the treatment of lipoprotein glomerulopathy.
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APOE-Okayama (R150G) and APOE-Modena (R150C) were located on the ε2 allele.
“We found that both APOE‐Okayama (R150G; Kinomura et al., 2008) and APOE‐Modena (R150C; Magistroni et al., 2013; Russi et al., 2009) were located on the ε2 allele, while APOE allele of APOE‐Guangzhou (R150P) was not reported (Luo et al., 2008).”
From Clinical and genetic analysis of lipoprotein glomerulopathy patients caused by <i>APOE</i> mutations (2020) · cites this paper as Russi et al., 2009
Another report indicates that plasma exchange using heparin-induced extracorporeal lipoprotein precipitation system can effectively treat LPG, significantly reducing cholesterol and triglycerides, because the system can activate LPL and hepatic triglyceride lipase through heparin, making TRL easier to clear.
“Another report indicates that plasma exchange using heparin-induced extracorporeal lipoprotein precipitation system can effectively treat LPG, significantly reducing cholesterol and triglycerides. This is because the heparin-induced extracorporeal lipoprotein precipitation system can activate LPL and hepatic triglyceride lipase through heparin, making TRL (such as VLDL and intermediate-density lip”
From A boy and his mother with lipoprotein glomerulopathy: Two case reports and literature review (2025) · cites this paper as [21]
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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
Tramontano, D., D'Erasmo, L., Larouche, M., Brisson, D., Lauzière, A., Di Costanzo, A., Bini, S., Minicocci, I., Covino, S., Baratta, F., et al. (2025) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2025.119146 · Cited by 23 · 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
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
Wang, R., Zhao, C., Chen, W., Liu, Z., & Xie, F. (2022) · Journal of Medical Case Reports · doi:10.1186/s13256-022-03302-0 · Cited by 5 · 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
- Russi, G., Furci, L., Leonelli, M., Magistroni, R., Romano, N., Rivasi, P., & Albertazzi, A.
- Affiliations
- Santa Maria Nuova Hospital (IT)
- Azienda Ospedaliero-Universitaria di Modena (IT)
- Corresponding author
- Russi, Gianpaolo
- Venue
- Journal of Medical Case Reports
- Published
- 2009-12
- Volume
- 3
- Issue
- 1
- Pages
- 9311-9311
- ISSN
- 1752-1947 (ISSN-L)
- PMC
- PMC2803834
- OpenAlex
- W1975095810
- Cited by
- 39
- References
- 1
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 3 · 2020: 1 · 2019: 3 · 2018: 2 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 8 · 2012: 2
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Medical Case Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Renal Diseases and Glomerulopathies
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipid metabolism and disorders
- Keywords
- lipoprotein glomerulopathy, LDL apheresis, nephrotic syndrome, proteinuria, hypercholesterolemia, renal failure, lipoprotein metabolism
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