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Plasma exchange in nephrology

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...
May 9, 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
Krzysztof Woźniak, Elżbieta Urbanowska, Emilian Snarski
Plasmapheresis also known as a therapeutic plasma exchange (TPE) is a procedure of plasma removal with it's ineligible plasma's component. Usually it is a supportive measure used simultaneously with the treatment, but in a few diseases, e.g. in trombotictrombocytopenic purpura (TTP), it is a first-choice treatment. During the plasmapheresis plasma is mostly replaced by 20% solution of albumin or combination of 20% solution of albumin and 0.9% solution of NaCl, however in some diseases fresh frozen plasma (FFP) is used...
2015: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Xiang-Dong Li, Zheng Liu, Ying Zhai, Ming Zhao, Hai-Yan Shen, Yi Li, Bo Zhang, Tao Liu
BACKGROUND: The Asian giant hornet is the largest wasp species in the world. Its stings can cause acute interstitial nephritis and acute renal failure. From July to October, 2013, Asian giant hornet attacks have killed 42 people and injured 1675 people with their powerful venomous stings in Hanzhong, Ankang, and Shangluo, three cities in the southern part of Shaanxi Province, China. CASE REPORT: We report here a case of a 42-year-old man with acute interstitial nephritis following multiple Asian giant hornet stings...
2015: American Journal of Case Reports
Julius J Schmidt, Jan T Kielstein
Fluids play an important role in clinical nephrology.1) Temperature of dialysate fluid has recently re-attracted a lot of attention. Individualized cooling of the dialysate (0.5 °C below predialysis ear temperature) has been shown to not only prevent intradialytic hypotension but also to improve myocardial contractility and to prevent white matter changes in CKD5D.2) Access fluid in AKI is associated with an increased mortality. While Furosemide has no place in treating AKI the Furosemide stress test can help to identify patients with AKI that will eventually need renal replacement therapy...
June 2015: Deutsche Medizinische Wochenschrift
B Puppe, E J Kingdon
Therapeutic plasma exchange (TPE) is a well-established treatment modality for nephrology patients, using two conventional methods: membrane (mTPE) or centrifugal TPE (cTPE). Although the efficacy of both treatments has been described, there are few reports that compare these methodologies. Here we describe three nephrology patients who were treated with both mTPE and cTPE. The mTPE method, but not the cTPE method, was associated with persistent difficulty anticoagulating the extracorporeal circuit in all three patients...
April 2014: Clinical Kidney Journal
Case Reports In Nephrology
[This retracts the article DOI: 10.1155/2014/243746.].
2015: Case Reports in Nephrology
Fabio Paglialonga, Claus Peter Schmitt, Rukshana Shroff, Karel Vondrak, Christoph Aufricht, Alan Rees Watson, Gema Ariceta, Michael Fischbach, Gunter Klaus, Tuula Holtta, Sevcan A Bakkaloglu, Alexandra Zurowska, Augustina Jankauskiene, Johan Vande Walle, Betti Schaefer, Elizabeth Wright, Roy Connell, Alberto Edefonti
BACKGROUND: Few observations on apheresis in pediatric nephrology units have been published. METHODS: This retrospective study involved children ≤18 years undergoing plasma exchange (PE), immunoadsorption (IA), or double filtration plasmapheresis (DFPP) in 12 European pediatric nephrology units during 2012. RESULTS: Sixty-seven children underwent PE, ten IA, and three DFPP, for a total of 738 PE and 349 IA/DFPP sessions; 67.2 % of PE and 69...
January 2015: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Fatiu A Arogundade, Abubakr A Sanusi, Stephen O Oguntola, Bolanle A Omotoso, Emaad M Abdel-Rahman, Adewale Akinsola, Rasheed A Balogun
Therapeutic apheresis (TA) refers to a group of extracorporeal blood treatment modalities with clinical indications for which the clinicians' knowledge, availability and applicability vary widely worldwide. Therapeutic plasma exchange (TPE), the most common TA technique, is neither readily available nor affordable in many parts of Africa. This article focuses on the challenges of starting a TPE program in a resource-constrained economy and the result of a survey of Nigerian nephrology professionals on TPE. A critical appraisal of published manuscripts from Nigeria on TA was undertaken to assess uses, methods, and challenges encountered followed by a survey of the perceptions of Nigerian nephrology professionals on TPE...
August 2014: Journal of Clinical Apheresis
Lidija Orlić, Branka Sladoje-Martinović, Ivana Mikolašević, Martina Pavletić Peršić, Ivan Bubić, Ita Jelić, Sanjin Rački
AIM: To describe the experience of the Department of Nephrology and Dialysis, University Hospital Rijeka, Croatia, in the treatment of patients with acute humoral rejection (AHR) of kidney transplant by using high dose of intravenous immunoglobulin (IVIG) alone and as a first line treatment. METHODS: Eight kidney transplant recipients in whom the AHR appeared at different time after the transplantation were reported. At the time of transplantation cross-match in all patients was negative for both T and B cells...
February 2014: Medicinski Glasnik
Zelal Ekinci, Cengiz Candan, Harika Alpay, Nur Canpolat, Sare Gülfem Akyüz, Zübeyde Gündüz, Ismail Dursun, Kenan Bek, Hasan Dursun, Emel Işıyel, Faruk Öktem, Yılmaz Tabel, İpek Akil, Ali Delibaş, Kaan Gülleroğlu, Nurver Akıncı, Nida Dinçel, Ozan Özkaya, Oğuz Söylemezoğlu
The aim of this retrospective multicenter study was to define the epidemiological and clinical features and prognostic factors of the first diarrhea-related hemolytic uremic syndrome (D+HUS) outbreak in Turkey in 2011. All pediatric nephrology centers in Turkey were asked about D+HUS patients via e-mail. Seventy D+HUS patients (median age: 5.7 years) participated. The seasonal peak was around the 7th, 8th and 9th months with 44 cases, centered in the east Marmara region. No causative agent could be identified...
May 2013: Turkish Journal of Pediatrics
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