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Kidney Int. 2016 Nov;90(5):974-984. doi: 10.1016/j.kint.2016.06.009. Epub 2016 Aug 3.

Plasmapheresis for the treatment of kidney diseases.

Author information

1
Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada. Electronic address: William.Clark@lhsc.on.ca.
2
Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada.
3
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
4
Department of Medicine, Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
5
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
6
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

Abstract

The purpose of this review is to examine the evidence supporting the application of plasma exchange in renal disease. Our review focuses on the following 6 most common renal indications for plasma exchange based on 2014 registry data from the Canadian Apheresis Group: (i) thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome; (ii) renal transplantation, (iii) anti-neutrophil cytoplasm antibodies-associated vasculitis, (iv) cryoglobulinemia, (v) focal segmental glomerulosclerosis, and (vi) Goodpasture syndrome. The rarity of these diseases and their rapid, often fatal course mean that randomized controlled studies of plasma exchange are rarely conducted. Although evidence from an adequately powered randomized controlled trial supports the use of plasma exchange to treat thrombotic thrombocytopenic purpura, the use of plasma exchange to treat other renal diseases is only supported by observational and mechanistic studies. Larger well-designed trials are needed to clarify the potential role of plasma exchange in renal disease. Growing international collaboration will improve the quality of future studies in this area.

KEYWORDS:

Goodpasture syndrome; anti–glomerular basement membrane disease; anti–neutrophil cytoplasm antibodies; focal segmental glomerulosclerosis; hemolytic uremic syndrome; plasmapheresis

PMID:
27498206
DOI:
10.1016/j.kint.2016.06.009
[Indexed for MEDLINE]

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