Plasmapheresis Reduces Proteinuria and Serum Capacity to Injure Glomeruli in Patients With Recurrent Focal Glomerulosclerosis

Artero, Mary; Sharma, Ram; Savin, Virginia J.; Vincenti, Flavio

doi:10.1016/s0272-6386(12)80381-7

Cited by 225 publications

(152 citation statements)

References 23 publications

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“…It may be causative in the proteinuria through a mechanism that includes lipid-dependent activation of the a5b3 integrin (44,45). One risk factor for recurrence is elevated permeability activity detected through an in vitro assay (44,46). The factor appears to be a small protein with one or more glycation sites, with an apparent molecular mass of approximately 50 kD (44).…”

Section: Recurrent Fsgsmentioning

confidence: 99%

Principles of Separation

Williams

Balogun

2014

Clinical Journal of the American Society of Nephrology

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SummaryExtracorporeal "blood purification," mainly in the form of hemodialysis has been a major portion of the clinical activity of many nephrologists for the past 5 decades. A possibly older procedure, therapeutic plasma exchange, separates and then removes plasma as a method of removing pathogenic material from the patient. In contrast to hemodialysis, therapeutic plasma exchange preferentially removes biologic substances of high molecular weight such as autoantibodies or alloantibodies, antigen-antibody complexes, and Ig paraproteins. These molecular targets may be cleared through two alternative procedures: centrifugal separation and membrane separation. This review presents operational features of each procedure, with relevance to the nephrologist. Kinetics of removal of these plasma constituents are based on the principles of separation by the apheresis technique and by features specific to each molecular target, including their production and compartmentalization in the body. Molecular targets for common renal conditions requiring therapeutic plasma exchange are also discussed in detail.

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Section: Recurrent Fsgsmentioning

confidence: 99%

Principles of Separation

Williams

Balogun

2014

Clinical Journal of the American Society of Nephrology

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“…In addition, abnormal T cell function was also proposed as a pathogenic factor [27][28]. Savin's group reported that plasmapheresis could diminish proteinuria and stabilize renal function in a part of patients with steroid-resistant idiopathic FSGS, suggesting that FSGS have some different local or systemic factor(s) unrelated to glomerular permeability [9][10]28]. In addition, a recent prospective trial in 10 patients at high-risk for FSGS recurrence because of rapid progression to renal failure (n = 4) or prior transplant recurrence of FSGS (n = 6) underwent a course of 8 PE treatments in the perioperative period.…”

Section: ) Nephrotic Syndromementioning

confidence: 99%

“…Circulating glomerular albumin permeability factor(s) were also detected in patients with native (primary) focal segmental glomerulosclerosis (FSGS) and recurrent FSGS after renal transplantation [4][5]. In such cases, plasma protein adsorption using Protein A sepharose cartridges [6][7] or anti-human immunoglobulin affinity immunoadsorption [7][8], plasma exchange (PE) [9][10], LDL apheresis [11] and/or LCAP [12] have been reported to be effective even for steroid-cyclosporin-A (CyA) resistant cases through removing the glomerular permeability factor(s) in some of these nephrotic patients. In this review, we overviewed the immunomodulation effects and clinical evidence of apheresis in various glomerular diseases, especially nephrotic syndrome and severe nephritic syndrome.…”

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confidence: 99%

Advances in apheresis therapy for glomerular diseases

et al. 2007

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This article overviewed the immunomodulation effects and clinical evidence of apheresis in renal diseases, especially primary and secondary glomerulonephritis. A considerable permeability factor(s) derived from circulating T cells is speculated to have a crucial role in proteinuria of nephrotic syndrome (NS). Plasma exchange (PE), immunoadsorption (IAPP) using Protein A sepharose cartridges, low density lipoprotein apheresis and lymphocyte apheresis (LCAP) were tried to remove such factors or pathogenic T cells. Other glomerular diseases induced by specific antibodies such as anti-glomerular basement membrane antibodies, anti-neutrophil cytoplasmic antibodies and immune-complexes were also treated with PE, double filtration plasma apheresis, IAPP and LCAP. The recommendations based on the evidence from recent randomized controlled studies have been established in apheresis therapy for the treatment of various glomerular diseases.

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“…Great importance is, therefore, attributed to plasma treatment and to the minimization or avoidance of substitution fluids. In this respect, the pilot experience of immunoadsorption in neurologic diseases [8] and of plasma detoxification in liver failure is important to be recognized [9], along with a protocol to assess the role of therapeutic apheresis in recurrent focal segmental glomerulosclerosis [10,11]. Another field of interest is the treatment of severe hypercholesterolemia, which a 10-year survey reveals to be the current most treated disease.…”

Section: Discussionmentioning

confidence: 99%

The Italian Registry for Therapeutic Apheresis. A report from the Apheresis Study Group of the Italian Society of Nephrology

Passalacqua¹,

Staffolani²,

Busnach

et al. 2005

J of Clinical Apheresis

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Many clinical indications and different technical issues have been reported on therapeutic apheresis: much criticism has also been recorded in several instances, mainly due to the lack of large clinical trials to validate collected data. A Registry where all the available data can be organized and analyzed therefore becomes a priority for all the professionals involved in apheresis. The purpose of this report is to describe the data submitted from 1994 to 2004 from 15,285 treatments on 1,477 patients from 44 Centers, including mainly, but not exclusively, Nephrological Units, collected by the Apheresis Study Group of the Italian Society of Nephrology in 15 Italian regions. Plasma exchange accounted for 56.2% of the procedures, and of these 50.4% were performed by filtration. Plasma treatment was used in 40.1% of procedures, namely with Protein A immunoadsorption (14.6%), LDL‐Cholesterol dextran sulfate adsorption (9.7%), and semiselective cascade or double filtration (12.6%). Cell apheresis, limited to photopheresis, was used in 0.85% of cases, and whole blood treatment (direct adsorption lipoprotein, and molecular adsorption recirculating system) in 2.7%. The procedures analyzed here account for less than 20% of estimated therapeutic apheresis performed in Italy, according to the national survey of activity performed for year 2000 by the Italian Apheresis Society. Notwithstanding that the data are largely incomplete, they are sufficiently informative for a definite trend: plasma treatment with filtration on fractionation filters and adsorption must be used as often as possible, instead of plasma exchange, thus obtaining the most selective removals. J. Clin. Apheresis © 2005 Wiley‐Liss, Inc.

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Plasmapheresis Reduces Proteinuria and Serum Capacity to Injure Glomeruli in Patients With Recurrent Focal Glomerulosclerosis

Cited by 225 publications

References 23 publications

Principles of Separation

Principles of Separation

Advances in apheresis therapy for glomerular diseases

The Italian Registry for Therapeutic Apheresis. A report from the Apheresis Study Group of the Italian Society of Nephrology

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