title: Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption.
abstract: BACKGROUND
  Anti-glomerular basement membrane (GBM) antibody disease may lead to acute crescentic glomerulonephritis with poor renal prognosis. Current therapy favours plasma exchange (PE) for removal of pathogenic antibodies. Immunoadsorption (IAS) is superior to PE regarding efficiency of antibody-removal and safety. Apart from anecdotal data, there is no systemic analysis of the long-term effects of IAS on anti-GBM-disease and antibody kinetics.
  
  
  OBJECTIVE
  To examine the long-term effect of high-frequency IAS combined with standard immunosuppression on patient and renal survival in patients with anti-GBM-disease and to quantify antibody removal and kinetics through IAS.
  
  
  METHODS
  Retrospective review of patients treated with IAS for anti-GBM-antibody disease confirmed by biopsy and/or anti-GBM-antibodies.
  
  
  METHODS
  University Hospital of Vienna, Austria.
  
  
  METHODS
  10 patients with anti-GBM-disease treated with IAS.
  
  
  METHODS
  Patient and renal survival, renal histology, anti-GBM-antibodies.
  
  
  RESULTS
  Anti-GBM-antibodies were reduced by the first 9 IAS treatments (mean number of 23) to negative levels in all patients. Renal survival was 40% at diagnosis, 70% after the end of IAS, 63% after one year and 50% at the end of observation (mean 84 months, range 9 to 186). Dialysis dependency was successfully reversed in three of six patients. Patient survival was 90% at the end of observation.
  
  
  CONCLUSIONS
  IAS efficiently eliminates anti-GBM-antibodies suggesting non-inferiority to PE with regard to renal and patient survival. Hence IAS should be considered as a valuable treatment option for anti-GBM-disease, especially in patients presenting with a high percentage of crescents and dialysis dependency due to an unusual high proportion of responders.
authors: Internal Medicine III/Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.
authors: Peter
authors: P
authors: Biesenbach
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors: Renate
authors: R
authors: Kain
authors: Internal Medicine III/Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.
authors: Kurt
authors: K
authors: Derfler
authors: Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors: Thomas
authors: T
authors: Perkmann
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors: Afschin
authors: A
authors: Soleiman
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors: Alexandra
authors: A
authors: Benharkou
authors: Internal Medicine III/Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.
authors: Wilfred
authors: W
authors: Druml
authors: Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria.
authors: Andrew
authors: A
authors: Rees
authors: Internal Medicine III/Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Vienna, Austria.
authors: Marcus D
authors: MD
authors: Säemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D010956:Plasmapheresis; D055815:Young Adult
chemical_list: D001323:Autoantibodies; C051951:antiglomerular basement membrane antibody