title: [Role of plasmapheresis in immunological kidney diseases. Experience from 1050 completed plasmapheresis treatment sessions].
abstract: Plasmapheresis is an effective treatment modality in several immunological kidney diseases. It is also indicated in certain neurological and hematological abnormalities, and some other diseases.
  
  
  OBJECTIVE
  In this study the indications and outcomes of the plasma exchange treatments performed in the Plasmapheresis Unit of the authors during the last 12 years are summarized, and the findings are compared to those published in the literature. The procedure, mechanisms of action and adverse effects are also briefly discussed.
  
  
  METHODS
  Between 1999 and 2010 authors completed 1050 plasma exchanges in 195 patients with an average 5.4 (1-20) treatments/person. In the 78 males and 117 females (age 57±16 years) the indications were as follows: 47% anti-cytoplasmic antibody-associated vasculitis, 4% anti-glomerular basement membrane disease, 3% rapidly progressing immunocomplex glomerulonephritis, 11% severe complications of systemic lupus erythematosus, 1% treatment resistant focal segmental glomerular sclerosis, 5% hemolytic uremic syndrome, 13% complications of multiple myeloma, 4% HELLP syndrome, 10% neurological diseases, and 2% other abnormalities.
  
  
  RESULTS
  Plasmapheresis, completed as part of combined immunosuppressive treatment, resulted in remarkable improvements in patients with anti-cytoplasmic antibody-associated vasculitis. Out of the 91 patients, 54 needed urgent dialysis on admission, and renal replacement therapy could be discontinued in 44% of them. Renal functions in those patients who did not need dialysis also improved significantly, and pulmonary hemorrhage ceased in all affected subjects. Survival of the patients with anti-glomerular basement membrane diseases was 100%. The treatment significantly improved the renal function in rapidly progressive lupus nephritis, and all the 5 cases of lupus cerebritis were successfully cured. The results showed less effectiveness in therapy resistant focal segmental glomerular sclerosis and in rapidly progressing immunocomplex glomerulonephritis. Plasmapheresis proved to be very efficient in cases with the primary hemolytic uremic syndrome, and each patient with HELLP syndrome recovered completely. The outcome of those with multiple myeloma was less favorable, although hyperviscosity was rapidly and effectively decreased by the plasmapheresis. The treatment improved the conditions of almost all patients with neurological diseases.
  
  
  CONCLUSIONS
  According to these findings plasmapheresis treatment, introduced by proper indications, effectively improves the outcomes of several diseases. Early diagnosis and immediate introduction of the plasmapheresis are very important - in conjunction with the appropriate therapy of the underlying diseases.
authors.affiliation: Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Szent Margit Kórház Nefrológia Osztály, Plazmaferézis Részleg Budapest Bécsi út 132. 1032. agnesharis@hotmail.com
authors.forename: Agnes
authors.initials: A
authors.lastname: Haris
authors.forename: József
authors.initials: J
authors.lastname: Arányi
authors.forename: Henrik
authors.initials: H
authors.lastname: Braunitzer
authors.forename: Eva
authors.initials: E
authors.lastname: Kálmán
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Merán
authors.forename: Mariann
authors.initials: M
authors.lastname: Soltész
authors.forename: Kálmán
authors.initials: K
authors.lastname: Polner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019867:Anti-Glomerular Basement Membrane Disease / Q000150:complications / Q000628:therapy; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000628:therapy; D017359:HELLP Syndrome / Q000276:immunology; D006463:Hemolytic-Uremic Syndrome / Q000150:complications / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000276:immunology* / Q000628:therapy*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications; D009422:Nervous System Diseases / Q000150:complications; D010951:Plasma Exchange / Q000009:adverse effects / Q000379:methods; D010956:Plasmapheresis / Q000009:adverse effects / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000628:therapy; D016896:Treatment Outcome; D014657:Vasculitis / Q000150:complications
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic