title: Role of plasmapheresis performed in hemodialysis units for the treatment of anti-neutrophilic cytoplasmic antibody-associated systemic vasculitides.
abstract: Anti-neutrophilic cytoplasmic antibody (ANCA) positivity is seen in some systemic necrotizing vasculitides. Wegener's granulomatosis and microscopic polyangiitis are among the ANCA-associated systemic vasculitides (AASV) and mortality is very high when renal failure occurs together with alveolar hemorrhage. The role of plasmapheresis in the treatment of these diseases has been studied retrospectively. Twelve patients with AASV who had plasmapheresis together with immunosuppressive medications have been involved. Primary diseases, immunosuppressive protocols, the number of plasmapheresis sessions, the amount of plasma that has been exchanged, urea and creatinine levels before and after treatment, pulmonary findings, the need for hemodialysis, and the outcome of patients were recorded. The mean age of patients was 52.9 ± 18.2 years. Wegener's granulomatosis was diagnosed in seven (58.3%) and microscopic polyangiitis in five (41.7%) patients. All patients had pulse cyclophosphamide and methylprednisolone followed by maintenance doses and plasmapheresis. Seven patients had hemodialysis at the beginning, and hemodialysis needed to be continued in three patients. Partial and complete remission was seen in 6 (50%) and 3 (25%) patients, respectively, and pulmonary findings regressed in all patients. End-stage renal disease develops generally in AASV due to rapidly progressive glomerulonephritis causing severe irreversible glomerular damage. The mortality rate rises to 50% in cases of renal failure with diffuse alveolar hemorrhage; therefore, pulse immunosuppressive treatment with plasmapheresis may be life-saving, as shown in our study.
authors.affiliation: Department of Nephrology, Haseki Training and Research Hospital, Istanbul, Turkey. zekiaydindr@yahoo.com
authors.forename: Zeki
authors.initials: Z
authors.lastname: Aydin
authors.forename: Meltem
authors.initials: M
authors.lastname: Gursu
authors.forename: Serhat
authors.initials: S
authors.lastname: Karadag
authors.forename: Sami
authors.initials: S
authors.lastname: Uzun
authors.forename: Emel
authors.initials: E
authors.lastname: Tatli
authors.forename: Abdullah
authors.initials: A
authors.lastname: Sumnu
authors.forename: Savas
authors.initials: S
authors.lastname: Ozturk
authors.forename: Rumeyza
authors.initials: R
authors.lastname: Kazancioglu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D055953:Microscopic Polyangiitis / Q000628:therapy*; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods*; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone