title: Still a role for plasma exchange in rapidly progressive glomerulonephritis?
abstract: Plasmapheresis combined with immunosuppression dramatically improved the survival of patients with Goodpasture's disease in the late 1970's. The presence of circulating pathogenic autoantibodies in this disease provided a logical rationale for the use of plasma exchange therapy. Careful analysis of the response to treatment has suggested that patients presenting with a serum creatinine < 600 mumol/I have the most benefit from plasma exchange. Subsequently plasmapheresis has been tried in a variety of other nephritides, predominantly those causing rapidly progressive glomerulonephritis, with variable success. Initial studies failed adequately to distinguish patients with a number of quite distinct causes of crescentic nephritis. However it has become clear that plasma exchange significantly improves the outcome of patients with pauci-immune crescentic glomerulonephritis who present with severe renal failure requiring dialysis, but not those with less severe renal disease.
authors.affiliation: Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Levy
authors.forename: C D
authors.initials: CD
authors.lastname: Pusey
mesh_terms: D019867:Anti-Glomerular Basement Membrane Disease / Q000628:therapy; D018450:Disease Progression; D005921:Glomerulonephritis / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D010951:Plasma Exchange / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome