Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

Abstract

Purpose This study aimed to assess efficacy of extracorporeal plasma therapy (EPT), including plasmapheresis (PE), immunoadsorption (IA), low-density lipoprotein apheresis (LDL-A), and lymphocytapheresis (LCAP) for adult native kidney patients with primary focal segmental glomerulosclerosis (FSGS). Methods A literature search was conducted using MEDLINE, EMBASE and Cochrane Databases through August 2022. Studies that reported outcomes of EPT in adult native kidneys with primary FSGS were enrolled. Results 18 studies with 104 therapy-resistant or refractory primary native FSGS patients were identified. Overall EPT response rate was 56%, with long-term benefit of 46%. Of the 101 non-hemodialysis (HD) patients, 54% achieved remission, with 30% complete remission (CR) and 23% partial remission (PR). Of 31 patients with PE, response rate was 65%; CR and PR rates were 27% and 37% in 30 non-HD patients. Of 61 patients with LDL-A, the response rate was 54%; CR and PR rates were 41% and 3% in 29 non-HD patients. Of 10 patients with IA, response rate was 40%. Of 2 patients with LCAP, 1 achieved CR, and one developed renal failure. All 3 HD patients showed increase in urine output and gradual decrease in urine protein excretion following PE ( n = 1) or LDL-A ( n = 2). 2 of 3 HD patients ultimately discontinued dialysis. Conclusion EPT with immunosuppressive therapy showed benefit in some patients with refractory primary FSGS, and PE appeared to have a higher response rate.

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

“…In an advanced immunosuppressive therapy-resistant setting, several novel treatments have been trialed with promising results. These include monoclonal antibodies such as various anti-TNFα antibodies (such as adalimumab) ( 45 ), as well as extracorporeal plasma therapy ( 46 ). Notably, apheresis treatment has also exhibited promising efficacy in INS patients unresponsive to immunosuppressive regimens ( 47 ).…”

Current approaches to overcome recurrent focal segmental glomerulosclerosis after kidney transplantation

“…Given the role of CPFs, it has been proposed that some patients may benefit from pretransplant plasmapheresis [21]. Plasmapheresis removes antibodies, immune complexes, inflammatory mediators, albumin, and other components from blood [22]. Plasmapheresis utilizes albumin or fresh frozen plasma as replacement fluid.…”

Efficacy and Safety of Plasma Exchange as an Adjunctive Therapy for Rapidly Progressive IgA Nephropathy and Henoch-Schönlein Purpura Nephritis: A Systematic Review

“…Plasmapheresis or plasma exchange (PLEX) is a therapeutic procedure involving the extracorporeal removal or exchange of blood plasma, which includes its components of antibodies and circulating antigen-antibody complexes [ 15 , 16 ]. PLEX has been beneficial in the treatment of crescentic glomerulonephritis or RPGN due to anti-glomerular basement membrane (GBM) antibody disease and ANCA-associated vasculitis (AAV) [ 17 , 18 ].…”