Effect of Early Plasmapheresis and Immunosuppressive Therapy on Natural History of Anti-glomerular Basement Membrane Glomerulonephritis

Idiopathic Rapidly Progressive Glomerulonephritis

“…Uncontrolled studies have shown very prom ising results in both Goodpasture's syndrome and idio pathic anti-GBM RPGN [126][127][128][129][130][131][132][133]. Anti-GBM antibody levels have been lowered by intensive plasmapheresis in most patients, but not all [133,135,136], Stabilization or improvement in renal function has been reported in over 50% of treated patients [32,38,[131][132][133], These results are clearly better than the 10-15% survival previously re ported in this disease [137] [128,131,134], It also reverses impaired reticuloendothelial system function in some patients which may further reduce circulating im mune complex levels [132,133,142], Not surprisingly, it is also associated with significant morbidity, usually bacte rial or opportunistic infections and pulmonary hemor rhage [132,133,143], This complication rate, as well as the very high cost ($ 750-1,000/4-liter exchange treatment in the US), make it unlikely that plasma exchange will ulti mately emerge as the treatment of choice for non-anti-GBM antibody-mediated forms of RPGN. However, more controlled data is required to answer this ques tion.…”