Cytapheresis for the treatment of myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis: report of five cases.
To minimize the adverse effects of high-dose administration of steroids and cyclophosphamide in patients with myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA), granulocytapheresis (GCAP) or leukocytapheresis (LCAP) was performed to reduce inflammation. Four patients with rapidly progressive glomerulonephritis (RPGN) and one patient with pulmonary hemorrhage due to MPO-ANCA-associated vasculitis were treated by cytapheresis. The prednisolone (PSL) dose was 0.28 +/- 0.15 mg/kg/day (mean +/- SD) (range 0.18-0.50 g/kg/day). In the 4 RPGN patients, the peak serum creatinine level was 3.7 +/- 1.9 mg/dl (range 1.7 to 5.6 mg/dl). GCAP was performed in 3 RPGN patients and in 1 pulmonary hemorrhage patient. LCAP was performed in 1 RPGN patient. In the 4 RPGN patients, renal function improved after combined therapy with cytapheresis and corticosteroids. In the pulmonary hemorrhage patient, evidence of pulmonary hemorrhage on chest computed tomography scanning diminished after combined therapy with cytapheresis and corticosteroids. Cytapheresis, when combined with a low-dose or intermediate-dose PSL regimen, is effective in the treatment of ANCA-associated vasculitis.
Hasegawa
Midori
M
Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan. mhase@fujita-hu.ac.jp
Kawamura
Nahoko
N
Kasugai
Masami
M
Koide
Sigehisa
S
Murase
Masamitsu
M
Asano
Sinsuke
S
Toba
Takako
T
Kushimoto
Hiroko
H
Murakami
Kazutaka
K
Tomita
Makoto
M
Shikano
Masahiko
M
Sugiyama
Satoshi
S
D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000628:therapy*; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology / Q000276:immunology / Q000628:therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006098:Granulocytes; D006801:Humans; D007937:Leukapheresis; D008171:Lung Diseases / Q000276:immunology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009195:Peroxidase / Q000276:immunology*; D011239:Prednisolone / Q000627:therapeutic use; D014657:Vasculitis / Q000150:complications / Q000276:immunology / Q000628:therapy*
D019268:Antibodies, Antineutrophil Cytoplasmic; D001323:Autoantibodies; D005938:Glucocorticoids; D011239:Prednisolone; D009195:Peroxidase