Influence of Immunoadsorption on the Removal of Immunoglobulin G Autoantibodies in Crescentic Glomerulonephritis

Abstract

We report the treatment of 5 patients with crescentic glomerulonephritis by immunoadsorption using a protein A column. Two had systemic vasculitis, 2 antiglomerular basement membrane disease and 1 systemic lupus erythematosus (SLE). In the patients with systemic vasculitis and SLE, there was successful removal of autoantibodies and rapid control of disease; remission was maintained over a mean follow-up of 2 years. Clinical improvement was not seen in 2 patients with anti-glomerular basement membrane (GBM) disease who presented with dialysis-dependent renal failure. There were no apparent clinical side-effects related to the immunoadsorption procedure. Protein A immunoadsorption offers a semiselective alternative to plasma exchange and appears to be safe and efficient in removing pathogenic autoantibodies in crescentic glomerulonephritis without anti-GBM antibodies.

Three Cases of C‐ANCA‐Positive Vasculitis Treated with Immunoadsorption: Possible Benefit in Early Treatment

“…Thus, considerably higher plasma volumes can be treated in 1 session without the side effects noted with plasma exchange. Consequently, elimination rates of pathologic antibodies are increased (12,13,15).…”

“…Although the effects of IA by both double‐column systems are convincing in theory, only a few clinical studies have been conducted (7,12,13). A recently published controlled and randomized Swedish study compared protein A IA with plasma exchange (7).…”

“…In addition to larger clinical studies attempting to define the role of classical plasma exchange in RPGN, a number of case series and case reports have been published to delineate the therapeutic effects of extracorporeal plasma purification procedures, including lymphocytapheresis, double membrane filtration, and various forms of immunoadsorption (IA) (8–14).…”

Apheresis in Lupus Nephritis

“…Studies involving SLE patients are anecdotal (50–52), and protein A immunoadsorption was used mainly in conjunction with immunosuppressive therapy (42). In a recent study, the efficient removal of antibodies and CICs was shown to correlate with surface markers of lymphocytes and monocytes (52,53).…”

Pulmonary-Renal Syndrome

“…There has been an improvement in the prognosis of PRS following the introduction of plasma exchange and immunosuppression; faster depletion of pathogenic autoantibodies using immunoadsorption with staphylococcal protein A or specific antibody removal against columns using recombinant antigens might have further advantages. 64,65 Of newer agents, intravenous immunoglobulin has led to recovery in refractory AASV, but there is no published experience in DPH. Prolonged antibiotic therapy with sulfamethoxazole/trimethoprim reduces relapse rates in WG, which is probably related to a reduction in the triggering effect of respiratory tract infection on vasculitis.…”