Role of therapeutic plasmapheresis in ANCA-associated vasculitis

Walters, Giles

doi:10.1007/s00467-014-3038-6

Cited by 19 publications

(8 citation statements)

References 31 publications

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“…In clinical daily practice, adding plasma exchange in the treatment of RPGN or diffuse alveolar hemorrhage improved the outcome . The eight randomized trials and the Cochrane Systematic Review reported that plasma exchange in severe AAV may be effective in reducing the development of ESRD by approximately 40% .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

et al. 2019

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We aimed to investigate the efficacy of plasma exchange on severe anti‐neutrophil cytoplasmic antibody‐associated vasculitis (AAV). Of 182 patients with AAV in our hospital, 12 patients with life‐threatening organ damage (rapidly progressive glomerulonephritis and/or diffuse alveolar hemorrhage) underwent centrifuge‐based therapeutic plasma exchange and immunosuppressive therapy. Twenty‐four patients matched for age, serum creatinine, and severity of vasculitis, who received high‐dose glucocorticoids with or without immunosuppressants, were included in the nonplasma exchange group. Renal survival rate at 2 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.524). Mortality rate at 5 years from induction treatment was not significantly different between the plasma and nonplasma exchange groups (P = 0.631). In this retrospective study, we could not show the significant differences in the renal survival rate and survival rate between the two groups.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

et al. 2019

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“…While plasmapheresis is more often used to treat cryoglobulinemia, it is only used in cases of severe renal failure requiring hemodialysis and/or pulmonary hemorrhage in ANCA disease [29, 30]. Given these differences, we recommend that HCV-infected patients with positive ANCA serologies should be thoroughly examined for other possible systemic manifestations, and that they undergo renal biopsy in order to confirm the presence of ANCA-associated GN, with or without coexisting cryoglobulinemic vasculitis.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis

Hanna

So²,

Kaldas

et al. 2018

Case Rep Nephrol Dial

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Hepatitis C (HCV) infection has a prevalence of 3 million infected individuals in the United States, according to recent Center for Disease Control reports, and can have various renal manifestations. Cryoglobulins, antibodies that precipitate at colder temperatures in vitro, are a relatively common cause of renal disease in HCV infection. The cryoglobulin proteins can form occlusive aggregates in small glomerular capillary lumina or deposit in other areas of the glomerulus, resulting in hypocomplementemia, proteinuria, hematuria, and renal injury. The typical biopsy pattern is that of membranoproliferative glomerulonephritis (MPGN). There are, however, other HCV-related patterns of glomerular injury. Anti-neutrophil cytoplasmic antibodies (ANCA) are known to exist in HCV-infected patients. In many reported cases, ANCA serologic testing may appear positive due to cross-reactivity of the immune assays; however, the biopsy findings do not support ANCA-associated crescentic glomerulonephritis (GN)/vasculitis as the primary cause of glomerular injury. There are rare reports of microscopic polyangiitis (MPA) p-ANCA vasculitis, in patients with HCV infection. In comparison with the MPGN pattern of cryoglobulinemic glomerular injury, biopsies from these HCV-infected patients with concomitant MPA revealed a crescentic GN, associated with normal serum complement levels. We present a case of HCV-associated glomerular disease with the surprising biopsy finding of necrotizing and crescentic p-ANCA GN, with a background, low-grade mesangial immune complex GN. Thus, p-ANCA disease should also be considered in HCV-infected patients, in addition to the more typical lesions of MPGN or cryoglobulinemic GN.

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“…The other option tried in this patient was antibody immune-adsorption via PLEX which has been demonstrated to be safe and well tolerated in pregnant women when used for other conditions [ 11 ]. Evidence thus far has shown some benefit of this therapy in AAV; however, many key questions remain unanswered [ 12 ]. Agents not tried in our patient included azathioprine (AZA) and rituximab (RTX).…”

Section: Discussionmentioning

confidence: 99%

Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy

Kunjal

Makary

Poenariu

2016

Case Reports in Nephrology

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Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis rarely affects females of reproductive age. A 28-year-old African American woman presented at 8 weeks of gestation with intractable vomiting attributed to hyperemesis gravidarum. She was found to have acute kidney injury that was unresponsive to vigorous fluid resuscitation and urine sediment examination was suggestive of an underlying glomerulonephritis. Serum c-ANCA and PR3 were elevated and there was no peripheral eosinophilia. During her course she also developed one episode of small volume hemoptysis with right upper lobe infiltrates on CT Chest. There were no cutaneous manifestations of vasculitis or upper respiratory symptoms. Renal biopsy revealed a pauci-immune crescentic glomerulonephritis (PICGN). The diagnosis was consistent with granulomatosis with polyangiitis (GPA). Management initially comprised teratogen sparing agents; steroids, intravenous immunoglobulin; and plasma exchange. The response was suboptimal and she became dependent on daily renal replacement therapy. Ultimately the pregnancy was terminated allowing for traditional treatment approaches with dramatic effect. This is the first case of GPA presenting as PICGN in pregnancy and highlights the challenges of its management.

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Role of therapeutic plasmapheresis in ANCA-associated vasculitis

Abstract: Plasma exchange, or plasmapheresis, is a treatment method that developed over a period of two decades and involves the removal and replacement of a patient's circulating plasma.

Cited by 19 publications

References 31 publications

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

Efficacy of Plasma Exchange in Anti‐Neutrophil Cytoplasmic Antibody‐Associated Vasculitis

Case Report: Patient with Hepatitis C, p-ANCA, and Cryoglobulin Antibodies Presenting with Necrotizing Crescentic p-ANCA Glomerulonephritis

Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy

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