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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 1  |  Page : 137-138
Plasmapheresis in renal diseases: Personal experience


Nephrology-Dialysis, Civic and Di Cristina Hospital, Palermo, Italy

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Date of Web Publication8-Jan-2015
 

How to cite this article:
Cavoli GL, Bono L, Tortorici C, Ferrantelli A, Giammarresi C, Rotolo U. Plasmapheresis in renal diseases: Personal experience. Saudi J Kidney Dis Transpl 2015;26:137-8

How to cite this URL:
Cavoli GL, Bono L, Tortorici C, Ferrantelli A, Giammarresi C, Rotolo U. Plasmapheresis in renal diseases: Personal experience. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2019 Jul 23];26:137-8. Available from: http://www.sjkdt.org/text.asp?2015/26/1/137/148763
To the Editor,

Plasmapheresis or plasma exchage (PE) is an extracorporeal therapy designed to remove large molecular weight substances from the plasma. Following the trials carried out and the recommendations of the American Society for Apheresis (ASFA) 2010, the role of therapeutic PE in nephropathy treatment has undergone many revisions. [1] In 2012, among the kidney diseases, the Canadian Apheresis Group reported thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) as the main indication for plasmapheresis (63% of the total cases); antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides were 14%, followed by renal transplantation (10%), Goodpasture's syndrome (6%) and focal segmental glomerulosclerosis (FSGS) post-transplantation (5%); cryoglobulinemia (2%) and nephropathy myeloma (< 1%) instead experienced a drastic reduction of cases; no cases of systemic lupus erythematosus (SLE) were reported. [2] Recent clinical studies have focused on the effect of PE toward rapidly progressive glomerulonephritis (GN) and hemorrhagic alveolitis. [3],[4] We reviewed 19 clinical records (ten male, nine female) inside our department from 2004 to 2011. Each patient received a PE session every 24-48 h for two weeks, but more treatments were sometimes carried out (up to 26 treatments). We chose a double-lumen catheter in the jugular or femoral vein for temporary vascular access and sodium citrate for anticoagulation. Except in HUS (in which we used fresh frozen plasma), we usually used albumin solution as the replacement fluid. The exchanged plasma volume (2-2.5 L) was dependent on the body weight of the patient and the hematocrit value, using the formula: plasma volume = body weight × 0.07 × (1hematocrit). We treated three Wegener's granulomatosis, four reno-pulmonary ANCA-associated vasculitides, three HUS, two cast-nephropathy of multiple myeloma, one crescentic GN with brain involvement, two crescentic GN alone, two SLE and one patient with membranoproliferative GN due to HCV-cryoglobulinemic vasculitis who was treated on two different occasions with plasmapheresis. PE treatments were always coupled with steroids and immunosuppressive therapy. All these cases were characterized by active bleeding (hemoptysis, metrorrhagia, epistaxis), severe dyspnea or rapid progression of renal failure without a favorable response to steroid treatment alone. In four cases, we observed the complete resolution of symptoms and normalization of renal function; seven patients improved their clinical status without an improvement in renal function; five patients improved both clinical status and renal function; and three cases had a fatal outcome. No complications associated with the PE procedure were described. The three patients who died were suffering from ANCApositive vasculitis with severe brain and renal involvement, ANCA-positive vasculitis with pulmonary involvement and renal failure and sepsis with severe active bleeding (hematuria). We believe that the systemic involvement and the late transfer to our department made both drug therapy and PE ineffective. The five subjects who gained a favorable and complete resolution were younger than the other patients and were suffering from SLE (three cases) and ANCA-positive vasculitis (two cases). We believe that the timely transfer to our department and the rapid onset of both drug treatment and PE have produced the successful result. We plan to optimize the use of PE and extend its use according to the international guidelines, and, in our opinion, a greater attention to growing therapeutic indications will increase its application and will improve the therapeutic efficacy.

Conflict of interest: None declared.

 
   References Top

1.
Szczepiorkowski ZM, Winters JL, Bandarenko N, et al. Guidelines on the use of therapeutic apheresis in clinical practice-Evidence-Based approach from the apheresis applications committee of the American Society for Apheresis. J Clin Apher 2010;25:83-177.  Back to cited text no. 1
    
2.
Clark WF. Plasma exchange for renal disease: Evidence and use 2011. J Clin Apher 2012;27:112-6.  Back to cited text no. 2
    
3.
Vanhille P, Vrigneaud L, Quéméneur T. Renal disease in ANCA-associated vasculitis. Presse Med 2012;41:247-53.  Back to cited text no. 3
    
4.
Casian A, Jayne D. Plasma exchange in the treatment of Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome and renal limited vasculitis. Curr Opin Rheumatol 2011;23:12-7.  Back to cited text no. 4
    

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Correspondence Address:
Dr. Gioacchino Li Cavoli
Nephrology-Dialysis, Civic and Di Cristina Hospital, Palermo
Italy
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DOI: 10.4103/1319-2442.148763

PMID: 25579735

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