Therapeutic Apheresis in Immunocomplex Nephritis
Journal of Clinical Nephrology and Therapeutics publishes the manuscripts that are directly or indirectly based on variegated aspects of clinical nephrology, diabetic nephropathy, pediatric nephrology, renal physiology, renal histopathology, immunobiology, intensive care nephrology, and ischemic nephropathy. Authors can submit their manuscripts to the online submission portal.
A case report titled: Therapeutic apheresis in immunocomplex nephritis: A case report of a successful treatment author by Rolf Bambauer which discuss the Immunocomplex nephritisThe advantages of the Therapeutic Apheresis (TA) with membrane modules, which became available since the mid-1970s, is a complete separation of the blood cells from the plasma. Autoimmune diseases have immune pathogenesis and can produce autoantibodies (ab) and Circulating Immune Complexes (CIC), which are the origin of inflammation in various organs. Most patients with these diseases have a poor prognosis without treatment. TA in combination with immunosuppressive drugs has brought an increase in the survival rates over the last 40 years.
The origin of autoimmune diseases is still generally unknown. The variety of autoimmune diseases ranges from those diseases in which auto immunization is solely responsible for the condition (e.g., autoimmune hemolytic anemia) to those in which it possibly has a major influence on the course of the disease (e.g., rheumatoid arthritis), and those in which the auto immunization results are probably only of diagnostic importance. The autoantibodies (auto-abs) activate different immunological processes that are self-destructive for the organs. These autoantibodies can be directed to all blood cells, too. With a case report of a woman, who was treated with Therapeutic Plasma Exchange (TPE) intermittently since her childhood, the authors show the efficacy of TPE in autoimmune diseases. The patients have had immunocomplex nephritis with a severe nephrotic syndrome which was diagnosed by a renal biopsy in the age of 14 months of the child. In the now more than 30 years old woman acute attacks of immunocomplex nephritis with nephrotic syndrome could be well controlled by TPE without excessive increases in the dosage of immunosuppressive drugs and significant impairment in renal function.
The prognosis of patients suffering from immunocomplex nephritis with or without the nephrotic syndrome, diagnosed by clinical symptoms, laboratory data such as circulating immune complexes and/or renal biopsy is poor. After a short time, the immunocomplex nephritis with or without NS needs hemodialysis and/or kidney transplantation. In moderate diseases immunosuppressive drugs such as corticosteroids alone or together with azathioprine, cyclophosphamide or biologic are sufficient. In severe cases of acute stages of the disease, many drugs can be applied as pulse therapy. But in severe cases failed to immunosuppression or to avoid severe complications due to the immunosuppressive drugs, TPE in combination with immunosuppression is indicated in an early stage of the disease. A number of 5 TPE or more are needed to control proteinuria or to eliminate CICs. If this therapy regiment is not enough additional TPE is necessary, once a week, or every 2 weeks, or once a month, as shown in the presented cases. The long-term benefit with the prevention of hemodialysis or kidney transplantation and other complications justify the high costs of TA. The treated volume must be 1–1.5 total plasma volume, the frequency every other day and the substitution solution a 5% human albumin-electrolyte solution and/or a 5% plasma protein solution and/or fresh frozen plasma.
Journal of Clinical Nephrology and Therapeutics