Advances in apheresis therapy for glomerular diseases.
This article is an overview of the immunomodulatory effects of apheresis in renal diseases, especially primary and secondary glomerulonephritis, and the clinical evidence for the efficacy of apheresis therapy. Permeability factor(s) derived from circulating T cells are speculated to have a crucial role in the proteinuria of nephrotic syndrome (NS). Plasma exchange (PE); immunoadsorption plasmapheresis (IAPP), using protein A sepharose cartridges; low-density lipoprotein apheresis; and lymphocytapheresis (LCAP) have been used to remove such factors or pathogenic T cells. Other glomerular diseases induced by specific antibodies such as anti-glomerular basement membrane antibodies, anti-neutrophil cytoplasmic antibodies, and immune-complexes have also been treated with PE, double-filtration plasmapheresis, IAPP, and LCAP. Recommendations, based on the evidence from recent randomized controlled studies, have been established in apheresis therapy for various glomerular diseases.
Yokoyama
Hitoshi
H
Division of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan. h-yoko@kanazawa-med.ac.jp.
Wada
Takashi
T
Division of Blood Purification, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
Zhang
Wei
W
Division of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
Yamaya
Hideki
H
Division of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
Asaka
Mitsuhiro
M
Division of Nephrology, Kanazawa Medical University School of Medicine, 1-1 Daigaku, Uchinada, Ishikawa, 920-0293, Japan.
D001781:Blood Component Removal / Q000379:methods* / Q000639:trends*; D005921:Glomerulonephritis / Q000628:therapy*; D006801:Humans; D007937:Leukapheresis / Q000379:methods; D009404:Nephrotic Syndrome / Q000628:therapy; D010951:Plasma Exchange / Q000379:methods; D010956:Plasmapheresis / Q000379:methods