Plasma exchange v peritoneal dialysis for removing Bence Jones protein.

Russell, Joanne; Fitzharris, Bernie; Corringham, Robert; Darcy, D. A.; Powles, R

doi:10.1136/bmj.2.6149.1397

Cited by 26 publications

(5 citation statements)

References 1 publication

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“…One component of this rebound represents a renewed synthesis of the substance, whereas another component is owing to the extravascular to intravascular redistribution of the substance. Many high-molecular-weight substances, such as the immunoglobulins, have a substantial extravascular distribution Table I [ [11][12][13][14][15][16][17][18][19][20][21][22]. After the rapid reduction in intravascular concentrations provided by the TPE treatment, the extravascular distribution of the substance will re-equilibrate with the intravascular space.…”

Section: General Guidelines For Prescribing Tpementioning

confidence: 99%

“…The basic tenets of immunoglobulin kinetics can be gleaned from the results of experiments in which isotopically labeled immunoglobulins have been infused into humans . These experiments have demonstrated that immunoglobulins have relatively long half lives, approaching 21 days for IgG and 5 days for IgM, immunoglobulins have a substantial extravascular distribution, approximately 60% for IgG and 20% for IgM, and immunoglobulins exhibit an intravascular to extravascular equilibration that is relatively slow, approximating 1–3% per hour .…”

Section: The Kinetics Of Immunoglobulin Removalmentioning

confidence: 99%

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Therapeutic plasma exchange: A technical and operational review

Kaplan

2013

J of Clinical Apheresis

119

129

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Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances. Examples of these substances include pathogenic autoantibodies, immune complexes, cryoglobulins, myeloma light chains, endotoxin and cholesterol containing lipoproteins. The basic premise of the treatment is that removal of these substances will allow for the reversal of the pathologic processes related to their presence. This review will cover the techniques for performing TPE, the kinetics of the removal of large molecules from the plasma and the benefits and risks of the different types of replacement fluids.

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Section: General Guidelines For Prescribing Tpementioning

confidence: 99%

Section: The Kinetics Of Immunoglobulin Removalmentioning

confidence: 99%

Therapeutic plasma exchange: A technical and operational review

Kaplan

2013

J of Clinical Apheresis

119

129

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“…In one report, 50 L of peritoneal dialysate removed only 2 grams in comparison with 17 grams with one 5 L PE treatment in patients with similar serum FLC levels. 81 However, significant amounts may be removed by HD using a protein leaking dialyser with very large pores. 82 The HCO membrane (Theralite™, Gambro) is a synthetic poly(arylene ether sulfone)/ polyvinylpyrrolidon (PAES/PVP) membrane available with 2.1 m 2 effective surface area.…”

Section: Reviewmentioning

confidence: 99%

Monoclonal Light Chains and the Kidney

Neuwirt

Rudnicki

Schramek

et al. 2011

Nephrology Research & Reviews

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Monoclonal proteins are most commonly associated with the malignant proliferation of plasma cells, called multiple myeloma (MM), which can cause a variety of renal disorders. Direct structural damage however is almost exclusively seen in the presence of light and / or heavy chains. This review provides an overview of kidney diseases in monoclonal disorders. Issues like epidemiology, impact on survival, pathology and pathophysiology will be summarized. Additionally, diagnostic measures and differential diagnosis are discussed. Furthermore this article focuses on special disease entities that primary involve glomerula (e.g. amyloidosis, monoclonal immunoglobulin deposition disease) or the tubulointerstitium (e.g. light chain cast nephropathy). Especially the issue of treating light chain cast nephropathy in patients with MM has become a focus of recent research in vitro and in vivo. New treatment options using special haemodialysers have instigated a fundamental discussion about utilizing this technology not only in MM patients with acute renal failure but also in those with reduced glomerular filtration rate due to cast nephropathy. We summarize the current status of treatment options of light chain cast nephropathy. Advantages of traditional compared to recently developed treatments will be discussed as well as modern chemotherapy protocols and the impact on overall survival and kidney function

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“…Patients with myeloma kidney are managed with chemotherapy and alkaline diuresis, along with TPE or peritoneal dialysis intended to reduce the precipitation of plasma paraproteins in the renal tubules. TPE is considered more effective than dialysis for this purpose [35][36][37]. Intensive TPE performed daily or every other day and using 5% albumin as replacement fluid is indicated for one to four weeks until the acute renal failure is relieved.…”

Section: Figure 1 Curve Relating the Plasma Concentration Of A Partimentioning

confidence: 99%

Applications of Therapeutic Apheresis in Patients with Malignant Disease

Pineda

Vamvakas

1997

The Oncologist

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Therapeutic apheresis (TA) provides the means for the removal of blood components that are abnormal or that circulate in excessive amounts and have a defined pathogenetic role, or are thought to have one. Multiple disease processes have been treated with TA at one time or another, but scientific assessment of the therapeutic effects of the procedure has lagged behind application of the technology. This led the American Medical Association and the American Society for Apheresis to publish position papers on the proper applications of TA. In the field of oncology, therapeutic plasma exchange (TPE) and related procedures may be the treatment of choice for some conditions (e.g., TPE for thrombotic thrombocytopenic purpura, therapeutic leukapheresis for extreme leukocytosis in acute myelogenous leukemia, etc.), or may represent a promising therapeutic modality whose efficacy needs to be established by randomized controlled trials in the future (e.g., photopheresis for the treatment of cutaneous graft-versus-host disease). Some applications should be considered strictly investigational, and should be offered to patients only if they are part of an approved research protocol (e.g., extracorporeal immunoadsorption with staphylococcal protein A for non-hematologic cancer). Routine use of TA should be restricted to conditions where the benefit has been established by controlled studies or the best available evidence.

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Plasma exchange v peritoneal dialysis for removing Bence Jones protein.

Cited by 26 publications

References 1 publication

Therapeutic plasma exchange: A technical and operational review

Therapeutic plasma exchange: A technical and operational review

Monoclonal Light Chains and the Kidney

Applications of Therapeutic Apheresis in Patients with Malignant Disease

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