Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus

Braun, Norbert; Erley, Christiane M.; Klein, Reinhild; Kötter, Ina; Saal, J. G.; Risler, T.

doi:10.1093/ndt/15.9.1367

Cited by 78 publications

(63 citation statements)

References 20 publications

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“…In particular, plasma exchange is not effective in the treatment of SLE [7]. However, immunoadsorption using protein A, C1q, or dextran sulfate cellulose columns has been shown to be useful for refractory SLE [8,9]. A recent open-label study of 16 patients with LN who were either refractory or intolerant to cyclophosphamide (CY) showed that vigorous removal of IgG by immunoadsorption was beneficial in most patients, with amelioration of proteinuria and global disease activity scores [10].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of the reports of lupus podocytopathy suggest that T cell activation plays an important role in the pathogenesis by altering the production of cytokines and circulating glomerular toxins, as proposed in idiopathic minimal change glomerulopathy [3,[17][18][19]. Since circulating autoantibodies and immune complexes may contribute significantly to the pathogenesis of SLE, an extracorporeal method for the removal of these pathological antibodies and complexes could be effective in the treatment of active LN [8]. The purpose of DFPP treatment is removal of pathologic hypermolecules, including cytokines and circulating glomerular toxins, in addition to the circulating autoantibodies and immune complexes in our case.…”

Section: Discussionmentioning

confidence: 99%

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Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

et al. 2012

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We describe a case of an adult female who presented with nephrotic syndrome. She was diagnosed with systemic lupus erythematosus with serum antinuclear antibodies, leucopenia with lymphopenia, butterfly erythema, and nephrotic syndrome. Renal biopsy revealed normal glomeruli with diffuse effacement of the foot processes, consistent with lupus podocytopathy. Although human albumin replacement was performed initially, acute renal failure developed rapidly. Therefore, she was treated with double filtration plasmapheresis (DFPP) in addition to oral steroid. After steroid therapy combined with DFPP, the renal function and proteinuria improved rapidly. Although the impact of DFPP on the treatment of lupus nephritis remains to be delineated, our observations suggest that DFPP in lupus podocytopathy played a pivotal role in facilitating the early recovery from renal injuries. Because of the rapid improvement of renal function without any change in body weight by DFPP, acute renal failure in the setting of lupus podocytopathy might contribute to an alternative pathophysiological factor for the diminished glomerular filtration rate, similar to that observed in the setting of idiopathic minimal change glomerulopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

et al. 2012

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“…Immunoadsorption using a C1q column to bind immune complexes, C-reactive protein, DNA, and other activators of the immune system has been used on eight adults [29] with some encouraging results. In addition, a staphylococcal protein A column has been used to remove antibodies and immune complexes in another report [30]. Both treatments were targeted at those with severe therapy-resistant SLE.…”

Section: Discussionmentioning

confidence: 99%

Retrospective study of plasma exchange in children with systemic lupus erythematosus

2004

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A retrospective review of patients was conducted to evaluate the short-term effect of therapeutic plasma exchange (TPE) in children with active systemic lupus erythematosus (SLE). Between April 1984 and March 2003, 22 children underwent 112 TPE sessions. The median number of daily, double-volume sessions was 6 (range 1-16). Plasma exchange was performed by centrifugation, using 4.5% albumin with fresh-frozen plasma as required. All children were receiving standard immunosuppressive therapy. The predominant clinical features that led to TPE were categorised into systems and outcome was evaluated according to clinical improvement or lack of it. There was benefit for central nervous system and pulmonary manifestations (10 cases, 11 episodes). Of 8 children treated for renal manifestations, 6 achieved good outcomes. Two children became dialysis dependent despite treatment; however, both had been successfully treated with TPE before. Five children received more than one course of TPE. No child died during the procedure and major complications were few. Our data show that TPE can be used as adjunctive therapy in childhood SLE with few complications. Outcome is difficult to measure but in our experience, during the acute phase of illness, TPE appears to be of benefit.

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“…Braun et al examined eight patients (six with LN class III or IV) with severe SLE resistant to conventional treatment who underwent extracorporeal immunoadsorption onto staphylococcal protein A (58). Most of the patients demonstrated a reduction in levels of anti-dsDNA antibody and circulating immune complexes, as well as improvement of disease activity and renal function with a reduction in serum creatinine levels and degree of proteinuria.…”

Section: Plasmapheresis and Immunoadsorptionmentioning

confidence: 99%

Lupus Nephritis

Kalloo

Aggarwal

Mohan

2013

Clinical Journal of the American Society of Nephrology

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SummaryLupus nephritis (LN) remains a major cause of ESRD and is associated with a >4-fold increase in mortality and significant morbidity in patients with lupus. The treatment of LN has evolved significantly over the past decade due to data from well conducted randomized controlled trials. We are currently in an era in which effective regimens exist in the form of induction and maintenance agents. Histopathologic classification of LN remains one of the main factors guiding therapy.

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Immunoadsorption onto protein A induces remission in severe systemic lupus erythematosus

Abstract: Immunoadsorption onto protein A might be used as an extracorporeal treatment option in SLE when other therapies are ineffective.

Cited by 78 publications

References 20 publications

Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

Accelerated recovery from nephrotic syndrome with acute renal failure by double filtration plasmapheresis in a patient with lupus podocytopathy

Retrospective study of plasma exchange in children with systemic lupus erythematosus

Lupus Nephritis

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