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Plasma exchange in nephrology

Luis Palma-Garcia, Victor Velásquez-Rimachi, Armando Pezo-Pezo, Joseph Roig, Julio Perez-Villegas
BACKGROUND: Therapeutic plasma exchange (TPE) is an extracorporeal procedure which consists of removing the patient's plasma and replacing it with an appropriate replacement fluid. Plasma and blood cells are separated by a centrifugation process. Our department has used TPE for several years, and in 2013 we introduced an institutional apheresis protocol. The main objective of this report is to describe the TPE procedures performed between 2013 and 2016 in the Peruvian population. METHODS: We analyzed the technical and clinical aspects of 864 centrifugal TPE procedures as well as the associated complications...
March 14, 2018: Journal of Clinical Apheresis
Moglie Le Quintrec, Anne-Laure Lapeyraque, Arnaud Lionet, Anne-Laure Sellier-Leclerc, Yahsou Delmas, Véronique Baudouin, Eric Daugas, Stéphane Decramer, Leila Tricot, Mathilde Cailliez, Philippe Dubot, Aude Servais, Catherine Mourey-Epron, Franck Pourcine, Chantal Loirat, Véronique Frémeaux-Bacchi, Fadi Fakhouri
BACKGROUND: Cases reports and small series of patients with C3 glomerulopathy have reported variable efficacy of eculizumab. STUDY DESIGN: Case series of C3 glomerulopathy. SETTING & PARTICIPANTS: Pediatric and adult patients with C3 glomerulopathy treated with eculizumab between 2010 and 2016 were identified through the C3 glomerulopathy French registry database, and a questionnaire was sent to participating French pediatric and adult nephrology centers, as well as one pediatric referral center in Québec, Canada...
February 8, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Anupama Kaul, Kavita Vishwakarma, Dharmendra Singh Bhaduaria, Prabhaker Mishra, Narayan Prasad, Manoj Jain, Venkatesh Thammshetti, Manas R Patel, Amit Gupta, Raj Kumar Sharma
PURPOSE: To look for incidence of pregnancy associated TMA, clinical presentation and impact of early diagnosis and institution of plasma exchange on overall renal outcomes METHODS: -This is a retrospective study among all female patients who presented with acute kidney injury post pregnancy between October 2002 to April 2016 in department of nephrology in a tertiary care hospital in northern India and diagnosed as pregnancy induced TMA. The patient were assessed for duration of onset of renal failure to time of diagnosis of TMA, role of modality of treatment ie plasmpaharesis to outcome...
February 2018: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Wladimir Szpirt, Joseph Schwartz
The rationale behind the use of plasma exchange (PE) includes the removal of autoantibodies and other plasma constituents, such as cytokines, complement components, neutrophil extracellular traps, and microparticles, and the substitution of missing plasma factors. The more established indications are associated with the beneficial effects of PE of reducing the plasma levels of pathogenic agents, although the efficiency of this process decreases during the course of the procedure as the substituted replacement fluid dilutes the patient's original plasma...
September 1, 2017: Nephrology, Dialysis, Transplantation
Olivier Moranne, Marie-Noëlle Peraldi, Gabriel Choukroun, Philippe Brunet, Éric Rondeau, Bruno Moulin
Due to a national theoretical training provided to all resident for many years and the ongoing discussions to change the organization of the resident training of specialized study diploma (SSD) of nephrology, a survey was done to assess the perception of skills acquired in the management of different clinical situations in terms of knowledge, expertise and attitudes. The expected results are intended to identify new training procedures for future nephrologists in France. The study was performed in 112 resident from 3rd and 4th year of nephrology resident training attending an educational seminar of the University College of Nephrology Teachers in May 2014...
December 2017: Néphrologie & Thérapeutique
Marco Allinovi, Calogero Lino Cirami, Leonardo Caroti, Giulia Antognoli, Silvia Farsetti, Maria Pia Amato, Enrico Eugenio Minetti
BACKGROUND: Interferon-beta (IFN-beta) is one of the most widely prescribed medications for relapsing-remitting multiple sclerosis (RRMS). IFN-related thrombotic microangiopathy (TMA) is a rare but severe complication, with a fulminant clinical onset and a possibly life-threatening outcome that may occur years after a well-tolerated treatment with IFN. Most patients evolve rapidly to advanced chronic kidney disease and eventually to renal failure. METHODS: We performed a retrospective analysis of TMA cases diagnosed and managed in our Nephrology Department from 2010 to 2015, and performed a literature review of IFN-beta-induced TMA...
October 2017: Clinical Kidney Journal
Edwin A Burgstaler, Sandra C Bryant, Jeffrey L Winters
PURPOSE: Terumo BCT Spectra Optia (O) and Fenwal Amicus (A) can perform therapeutic plasma exchange (TPE). We compared these systems in a prospective, randomized, crossover study of 81 paired procedures. Primary objective was to determine if there was a difference in platelet loss between the instruments. Secondary objectives were to determine differences in procedure time (PT), plasma removal efficiency (PRE 1), plasma removal rate (PRR), and fluid balance (FB). METHODS: Fifty-seven adults undergoing 162 procedures were included...
September 23, 2017: Journal of Clinical Apheresis
Mattia Parolin, Enrico Vidal
In the setting of kidney transplantation, therapeutic apheresis (TA) is employed both for pre-intervention procedures and during the post-transplant period. In pediatric nephrology units, TA is usually performed as a therapeutic plasma exchange (TPE) with dialysis equipment, and using non-plasma replacement fluids. In children undergoing kidney transplantation, complications of TPE are mainly related to its depletive properties combined with the iatrogenic immunodeficiency status of the patient. Moreover, the use of small central venous catheters and the equipment standardized for adults can increase the risk of adverse events...
August 2017: Transfusion and Apheresis Science
A V Smirnov, A V Karunnaya, V A Dobronravov
AIM: To analyze cases of complement-mediated thrombotic microangiopathy (C-TMA) in the daily practice of a hospital nephrology department, relative to the general aspects of the clinical course, therapy, and short-term outcomes. SUBJECTS AND METHODS: The prospective study conducted in the period June 1, 2015 to June 1, 2016 included 10 patients with C-TMA newly diagnosed during hospitalization. Standard demographic parameters, generally accepted clinical data showing the severity of TMA and the involvement of vital organs were recorded at admission...
2017: Terapevticheskiĭ Arkhiv
Bruna Brunetta Gavranić, Nikolina Bašić-Jukić, Vedran Premužić, Petar Kes
BACKGROUND: Administration of an anticoagulant during therapeutic plasma exchange (TPE) is necessary to avoid circuit clotting and impaired treatment effectiveness. Citrate is the preferred anticoagulant for apheresis worldwide, and unfractionated heparin (UH) is the second most preferred, yet there are only a few published studies regarding the use of UH during TPE. There are even fewer studies regarding the use of low-molecular-weight heparin (LMWH) and TPE performed without anticoagulation...
December 2017: Journal of Clinical Apheresis
Julien Demiselle, Johann Auchabie, François Beloncle, Philippe Gatault, Steven Grangé, Damien Du Cheyron, Jean Dellamonica, Sonia Boyer, Dimitri Titeca Beauport, Lise Piquilloud, Julien Letheulle, Christophe Guitton, Nicolas Chudeau, Guillaume Geri, François Fourrier, René Robert, Emmanuel Guérot, Julie Boisramé-Helms, Pierre Galichon, Pierre-François Dequin, Alexandre Lautrette, Pierre-Edouard Bollaert, Ferhat Meziani, Loïc Guillevin, Nicolas Lerolle, Jean-François Augusto
PURPOSE: Data for ANCA-associated vasculitis (AAV) patients requiring intensive care are scarce. METHODS: We included 97 consecutive patients with acute AAV manifestations (new onset or relapsing disease), admitted to 18 intensive care units (ICUs) over a 10-year period (2002-2012). A group of 95 consecutive AAV patients with new onset or relapsing disease, admitted to two nephrology departments with acute vasculitis manifestations, constituted the control group...
December 2017: Annals of Intensive Care
Christophe Ridel, Sébastien Kissling, Laurent Mesnard, Alexandre Hertig, Éric Rondeau
Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Compensation by viro-attenuated plasma is reserved solely for the treatment of thrombotic microangiopathies or when there is a risk of bleeding, because this product is very allergenic and expensive...
February 2017: Néphrologie & Thérapeutique
Rolf Bambauer, Reinhard Latza, Daniel Burgard, Ralf Schiel
Since the mid 1970s, when membrane modules became available, plasma separation techniques have gained in importance especially in the past few years. The advantages of this method are a complete separation of the corpuscular components from the plasma and due to increased blood flow rate and higher efficacy. Systemic autoimmune diseases based on an immune pathogenesis produce autoantibodies and circulating immune complexes, which cause inflammation in the tissues of various organs. In most cases, these diseases have a poor prognosis without treatment...
February 2017: Therapeutic Apheresis and Dialysis
Rolf Bambauer, Reinhard Latza, Daniel Burgard, Ralf Schiel
The process of curing a patient by removing his illness by extracting blood is a very old one. Many years ago, phlebotomy was practiced to cure illness. Now, this old process, placed on a rational basis with therapeutic apheresis (TA), is being followed in clinical practice. Therapeutic plasma exchange (TPE) with hollow fiber modules has been used in different severe diseases for more than 40 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors herein give an overview of TA in immunological diseases, especially in hematologic, autoimmune and dermatologic diseases...
October 2016: Therapeutic Apheresis and Dialysis
Kevin W Finkel, Eric P Cohen, Anushree Shirali, Ala Abudayyeh
Nearly 50% of patients with multiple myeloma develop renal disease, most commonly from AKI caused by cast nephropathy. Development of AKI is associated with poor 1-year survival and reduces the therapeutic options available to patients. There is a great need for more effective therapies. Cast nephropathy is caused by the interaction and aggregation of filtered free light chains and Tamm-Horsfall protein causing intratubular obstruction and damage. The key to treating cast nephropathy is rapid lowering of free light chains, because this correlates with renal recovery...
December 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Michael E Stevenson, Nelson Leung, Jeffrey L Winters
No abstract text is available yet for this article.
September 2016: Seminars in Dialysis
Tokiko Miyaoka, Mitsuyo Itabashi, Saeko Kumon, Kenichi Akiyama, Yuko Iwabuchi, Hiroshi Kataoka, Takahito Moriyama, Takashi Takei, Kosaku Nitta
We report a patient treated with rituximab for interstitial pneumonia (IP) associated with microscopic polyangiitis (MPA) and who was undergoing hemodialysis. A 59-year-old woman who had been treated with tacrolimus for 1 year for rheumatic arthritis was referred to the Department of Nephrology for fatigue, fever, weight loss, and rapidly developing renal dysfunction. On the first admission, severe renal dysfunction, proteinuria, hematuria, and an elevated titer of MPO-ANCA were observed, and the woman was diagnosed with rapidly progressive glomerulonephritis because of MPA...
2016: Nihon Jinzo Gakkai Shi
T Rogier, M Gerfaud-Valentin, C Pouteil-Noble, A Taleb, M Guillet, A Noel, C Broussolle, P Sève
INTRODUCTION: Gemcitabine-induced thrombotic microangiopathy is a rare event whose management is not yet consensual. The use of eculizumab could be of interest. CASE REPORT: A 68-year-old woman was treated by gemcitabine as adjuvant chemotherapy of a pancreatic adenocarcinoma. Two months later, the patient presented with mechanical hemolytic anemia, thrombocytopenia and high blood pressure that led to the diagnosis of thrombotic microangiopathy. Gemcitabine was stopped...
October 2016: La Revue de Médecine Interne
Bruna Brunetta Gavranić, Nikolina Bašić-Jukić, Petar Kes
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique designed for the removal of substances with large molecular weight from the plasma. However, it is not commonly performed in children and the elderly because of concern of potential complications. The Department of Nephrology at Zagreb University Hospital Centre's database (8335 procedures, 981 patients) was retrospectively analyzed from 1982 to 2011 to record indications, applications, and safety of TPE use in children (≤18 years), adults (>18 and <65 years), and elderly patients (≥65 years)...
August 2016: Artificial Organs
Sudheer Kumar Reddy, Afsana Jahan, Swasti Chaturvedi, Indira Agarwal
BACKGROUND: Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. OBJECTIVES: We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. METHODS: A retrospective chart review of children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchange was undertaken...
December 2015: Clinical Kidney Journal
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