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Comparison of double filtration plasmapheresis with immunoadsorption therapy in patients with anti-glomerular basement membrane nephritis.

Zhang YY, Tang Z, Chen DM, Gong DH, Ji DX, Liu ZH - BMC Nephrol (2014)

Bottom Line: Renal function and outcome were determined.Efficacy of clearing anti-GBM antibody was similar in the two groups (59.0 vs. 71.2%, P = 1.00), although fewer patients in the DFPP group experienced reduced IgG (62.7 vs. 83.5%, p = 0.002).DPPP plus immunosuppressive therapy efficiently and safely removed anti-GBM antibodies.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P, R, China. tang_dr@163.com.

ABSTRACT

Background: Double filtration plasmapheresis (DFPP) and (IA) are both used to clear antibody. However, the clinical efficacy and safety of DFPP in patients with anti-glomerular basement membrane (anti-GBM) disease are unclear.

Methods: The 28 enrolled patients diagnosed serologically and pathologically with anti-GBM disease from 2003 to 2013 included 16 treated with DFPP and 12 with IA, with all patients administered immunosuppressive agents. DFPP consisted of an EC50W filter for plasma separation and an EC20W filter for plasma fractionation. A double volume of plasma was processed, and each patient received a 30-40 g human albumin supplement during each session. IA consisted of 10 cycles per session, with 8-10 sessions performed daily or every other day and each session regenerating 30-60 L of plasma. Serum anti-GBM antibodies and IgG were measured, and urinary and blood tests were performed, before and after each procedure. Renal function and outcome were determined.

Results: The 28 patients consisted of 13 males and 15 females, of median age 44.5 years (range, 22.5-57 years). Six patients had pulmonary hemorrhage and 18 had serum creatinine concentrations >500 umol/L. The average serum creatinine concentration at early onset of disease was 525 umol/L while the peak concentration was 813 umol/L. All patients showed progressive increases in serum creatinine and required CRRT during the course of disease. Pathological examination showed an average 73.9% of crescents (range, 54.6-95.4%).The clinical and pathological features of the DPPP and IA groups were similar. Efficacy of clearing anti-GBM antibody was similar in the two groups (59.0 vs. 71.2%, P = 1.00), although fewer patients in the DFPP group experienced reduced IgG (62.7 vs. 83.5%, p = 0.002). One patient each had a pulmonary hemorrhage and a subcutaneous hemorrhage during treatment, but there were no other serious complications. At the end of follow-up, patient survival and renal survival were similar in the DFPP and IA groups.

Conclusion: DPPP plus immunosuppressive therapy efficiently and safely removed anti-GBM antibodies. The fewer plasma-associated side effects and reduced loss of IgG suggest that DFPP may be a better treatment choice for anti-GBM disease, especially in patients with insufficient plasma.

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Effects of IA and DFPP on concentrations of anti-GBM antibodies and IgG in individual patients: In DFPP group, the average reduction of anti-GBM-antibody was 123.7 RU/ml(61.9%), as did the average reduction of IgG was 8.2 g/L(62.7%). Similarly, in the IA group the average reduction of anti-GBM-antibody was 142 RU/ml(70.8%), as did the average reduction of IgG was 10.6 g/L(82.5%).
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Figure 1: Effects of IA and DFPP on concentrations of anti-GBM antibodies and IgG in individual patients: In DFPP group, the average reduction of anti-GBM-antibody was 123.7 RU/ml(61.9%), as did the average reduction of IgG was 8.2 g/L(62.7%). Similarly, in the IA group the average reduction of anti-GBM-antibody was 142 RU/ml(70.8%), as did the average reduction of IgG was 10.6 g/L(82.5%).

Mentions: Following the DFPP sessions, the concentration of anti-GBM-antibody declined significantly, from 210 to 86.3 RU/ml (P < 0.01), a reduction of 123.7 RU/ml or 61.9%, as did the concentration of IgG, from 12.4 to 4.2 g/L, a reduction of 8.2 g/L or 62.7% (Table 3, Figure 1). Similarly, the concentration of anti-GBM antibody in the IA group declined from 199 to 57.0 RU/ml, a reduction of 142 RU/ml or 70.8%, and the concentration of IgG from 12.7 to 2.1 g/L, a reduction of 10.6 g/L or 82.5%. The change in IgG concentration differed significantly in the two groups (p = 0.049), whereas the change in anti-GBM concentration did not (p = 0.452).


Comparison of double filtration plasmapheresis with immunoadsorption therapy in patients with anti-glomerular basement membrane nephritis.

Zhang YY, Tang Z, Chen DM, Gong DH, Ji DX, Liu ZH - BMC Nephrol (2014)

Effects of IA and DFPP on concentrations of anti-GBM antibodies and IgG in individual patients: In DFPP group, the average reduction of anti-GBM-antibody was 123.7 RU/ml(61.9%), as did the average reduction of IgG was 8.2 g/L(62.7%). Similarly, in the IA group the average reduction of anti-GBM-antibody was 142 RU/ml(70.8%), as did the average reduction of IgG was 10.6 g/L(82.5%).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4127070&req=5

Figure 1: Effects of IA and DFPP on concentrations of anti-GBM antibodies and IgG in individual patients: In DFPP group, the average reduction of anti-GBM-antibody was 123.7 RU/ml(61.9%), as did the average reduction of IgG was 8.2 g/L(62.7%). Similarly, in the IA group the average reduction of anti-GBM-antibody was 142 RU/ml(70.8%), as did the average reduction of IgG was 10.6 g/L(82.5%).
Mentions: Following the DFPP sessions, the concentration of anti-GBM-antibody declined significantly, from 210 to 86.3 RU/ml (P < 0.01), a reduction of 123.7 RU/ml or 61.9%, as did the concentration of IgG, from 12.4 to 4.2 g/L, a reduction of 8.2 g/L or 62.7% (Table 3, Figure 1). Similarly, the concentration of anti-GBM antibody in the IA group declined from 199 to 57.0 RU/ml, a reduction of 142 RU/ml or 70.8%, and the concentration of IgG from 12.7 to 2.1 g/L, a reduction of 10.6 g/L or 82.5%. The change in IgG concentration differed significantly in the two groups (p = 0.049), whereas the change in anti-GBM concentration did not (p = 0.452).

Bottom Line: Renal function and outcome were determined.Efficacy of clearing anti-GBM antibody was similar in the two groups (59.0 vs. 71.2%, P = 1.00), although fewer patients in the DFPP group experienced reduced IgG (62.7 vs. 83.5%, p = 0.002).DPPP plus immunosuppressive therapy efficiently and safely removed anti-GBM antibodies.

View Article: PubMed Central - HTML - PubMed

Affiliation: National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, P, R, China. tang_dr@163.com.

ABSTRACT

Background: Double filtration plasmapheresis (DFPP) and (IA) are both used to clear antibody. However, the clinical efficacy and safety of DFPP in patients with anti-glomerular basement membrane (anti-GBM) disease are unclear.

Methods: The 28 enrolled patients diagnosed serologically and pathologically with anti-GBM disease from 2003 to 2013 included 16 treated with DFPP and 12 with IA, with all patients administered immunosuppressive agents. DFPP consisted of an EC50W filter for plasma separation and an EC20W filter for plasma fractionation. A double volume of plasma was processed, and each patient received a 30-40 g human albumin supplement during each session. IA consisted of 10 cycles per session, with 8-10 sessions performed daily or every other day and each session regenerating 30-60 L of plasma. Serum anti-GBM antibodies and IgG were measured, and urinary and blood tests were performed, before and after each procedure. Renal function and outcome were determined.

Results: The 28 patients consisted of 13 males and 15 females, of median age 44.5 years (range, 22.5-57 years). Six patients had pulmonary hemorrhage and 18 had serum creatinine concentrations >500 umol/L. The average serum creatinine concentration at early onset of disease was 525 umol/L while the peak concentration was 813 umol/L. All patients showed progressive increases in serum creatinine and required CRRT during the course of disease. Pathological examination showed an average 73.9% of crescents (range, 54.6-95.4%).The clinical and pathological features of the DPPP and IA groups were similar. Efficacy of clearing anti-GBM antibody was similar in the two groups (59.0 vs. 71.2%, P = 1.00), although fewer patients in the DFPP group experienced reduced IgG (62.7 vs. 83.5%, p = 0.002). One patient each had a pulmonary hemorrhage and a subcutaneous hemorrhage during treatment, but there were no other serious complications. At the end of follow-up, patient survival and renal survival were similar in the DFPP and IA groups.

Conclusion: DPPP plus immunosuppressive therapy efficiently and safely removed anti-GBM antibodies. The fewer plasma-associated side effects and reduced loss of IgG suggest that DFPP may be a better treatment choice for anti-GBM disease, especially in patients with insufficient plasma.

Show MeSH
Related in: MedlinePlus