Treatment of Rapidly Progressive Glomerulonephritis by Extracorporeal Immunoadsorption, Prednisolone and Cyclophosphamide

Palmer, Anthony J.; Cairns, Tom; Dische, F. E.; Gluck, G.; Gjörstrup, P.; Parsons, V.; Welsh, K; Taube, David

doi:10.1093/ndt/6.8.536

Cited by 54 publications

(30 citation statements)

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“…In addition to larger clinical studies attempting to define the role of classical plasma exchange in RPGN, a number of case series and case reports have been published to delineate the therapeutic effects of extracorporeal plasma purification procedures, including lymphocytapheresis, double membrane filtration, and various forms of immunoadsorption (IA) (8–14).…”

mentioning

confidence: 99%

Three Cases of C‐ANCA‐Positive Vasculitis Treated with Immunoadsorption: Possible Benefit in Early Treatment

Matic¹,

Michelsen

Hofmann

et al. 2001

Therapeutic Apheresis

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Wegener's granulomatosis is a vasculitic disease predominantly affecting the upper respiratory tract, lungs, and kidneys. Three patients with Wegener's granulomatosis and rapidly progressive glomerulonephritis were treated with an intensified regimen of immunoadsorption (IA) (Excorim or Therasorb) in addition to cyclophosphamide (CYC) and methylprednisolone (PRE). Patient A had been in remission under oral CYC/PRE. The first exacerbation was treated successfully with 4 IA treatments without changing medication. Patient B experienced 3 flares within 1 year, which were treated with 28 IA (3–7 IAs/course), intravenous CYC after each course, and PRE. A fall of creatinine levels from 120 to 190 μmol/L to 100 μmol/L was noted after IA and before administration of CYC. Patient C presented in uremia. Autoantibodies were eliminated by 11 IA treatments parallel to CYC/PRE therapy. They remained within a normal range for >1 year's follow‐up; however, kidney function did not return. In conclusion, the observations in Patients A and B suggest a beneficial therapeutic effect of early IA in WG.

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mentioning

confidence: 99%

Three Cases of C‐ANCA‐Positive Vasculitis Treated with Immunoadsorption: Possible Benefit in Early Treatment

Matic¹,

Michelsen

Hofmann

et al. 2001

Therapeutic Apheresis

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“…Intravenous cyclophosphamide is not established in RPGN [26]. The benefit of additional plasma exchange or immunoadsorption is still under debate [15,[27][28][29]. The effect of synchronized plasmapheresis/cyclophosphamide pulse therapy is not clear [30].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for long-term survival and renal function in 64 patients with rapidly progressive glomerulonephritis (RPGN)

Keller

Michaelis

Büttner³

et al. 1994

Geriatric Nephrol Urol

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Abstract:The long-term outcome in rapidly progressive glomerulonephritis (RPGN) is a subject of increasing clinical attention. We performed a retrospective study of 64 patients, who were treated between 1972 and 1990 for biopsy-confirmed RPGN (median observation time 3.3 years). The incidence of RPGN displayed a linear increase with age, and 41 percent of the patients were older than 60 years (26/64). Fifty-one of the 64 patients (80%) were treated with immunosuppressives (steroid pulses, cyclophosphamide, azathioprine, prednisolone, plasma exchange). Of the 13 patients not receiving immunosuppresion, 12 were diagnosed as cases of "idiopathic" RPGN. Anti-neutrophil cytoplasmatic antibodies (ANCA) were tested for in 6 of the 64 patients, of whom 2 with systemic immune disease were cANCA positive. In the Kaplan-Meier analysis, the overall 5-year patient survival rate with the 95 percent confidence interval [95% CI] was 70 percent [47%-93%] and did not differ for immunosuppressed and nonspecifically treated patients. Kaplan-Meier probability of life-sustaining renal function was significantly better in 51 immunosuppressed patients (p = 0.03) compared to 13 nonspecifically treated patients, and the efficacy of immunosuppression in patients older than 60 years was comparable to that in younger patients. After 5-years, the proportion of patients with maintained renal function was only 27 percent [0%-57%] in the immunousppressed patients. From the multivariate Cox model, it was evident that immunosuppression had no independent beneficial effect on renal function, whereas the 20 patients with initial oliguria (< 500 ml/d) bad a significantly increased relative risk of 2.0 of losing renal function [1.1-3.6] compared to those without oliguria. In the Cox model, success of immunosuppression was independent of age, but the relative risk of death was at 5.3 significantly higher in patients over 60 years of age [2.0-13.9] compared to those younger than 60 years. Within the observation period, 24 patients died, 10 due to complications of immunosuppression (4 infections, 6 malignancies). We conclude that intensive immunosuppression should be given to all patients with RPGN irrespective of patient's age, but long-term efficacy is limited, complication rate is high, and initial oliguria is the most significant risk factor for loss of renal function.

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“…Palmer et al [6] treated ten patients with RPGN and acute renal failure with PAIA, prednisolone and cyclophosphamide. Three of the patients had SLE, five had microscopic polyarteritis, and two had Wegener's granulomatosis.…”

Section: Rapidly Progressive Glomerulonephritismentioning

confidence: 99%

Extracorporeal immunoadsorption with protein A: Technical aspects and clinical results

Samuelsson

2001

J of Clinical Apheresis

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The use of therapeutic plasma exchange (TPE) for removal of large molecular‐weight substances form patients' circulation is limited by the method's non‐selectivity and non‐specificity. In order to remove the target amount of pathogenic substance, usually amounting to less than 1 g per liter of plasma, one will also remove 60‐80 g of proteins, some of which are essential. A further disadvantage of the method is the need for substitution fluids, which at least in some countries are expensive and of limited availability. Furthermore, there is a (low) risk of disease transmission.To overcome these limitations, the principle of affinity chromatography used in biochemistry was applied in medicine to develop the Excorim Extracorporeal Immunoadsorption System in the beginning of the 1980s [1].

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Treatment of Rapidly Progressive Glomerulonephritis by Extracorporeal Immunoadsorption, Prednisolone and Cyclophosphamide

Cited by 54 publications

References 0 publications

Three Cases of C‐ANCA‐Positive Vasculitis Treated with Immunoadsorption: Possible Benefit in Early Treatment

Three Cases of C‐ANCA‐Positive Vasculitis Treated with Immunoadsorption: Possible Benefit in Early Treatment

Risk factors for long-term survival and renal function in 64 patients with rapidly progressive glomerulonephritis (RPGN)

Extracorporeal immunoadsorption with protein A: Technical aspects and clinical results

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