title: Plasma exchange for paediatric kidney disease-indications and outcomes: a single-centre experience.
abstract: BACKGROUND
  Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce.
  
  
  OBJECTIVE
  We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases.
  
  
  METHODS
  A retrospective chart review of children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchange was undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis.
  
  
  RESULTS
  Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5-15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody-associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96-7.85] mg/dL with a mean eGFR of 43 (IQR 27.54-56.7) mL/min/1.73 m(2). Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5-26), dialysis and immunosuppressive therapy. The mean duration of follow-up was 4 months (range 2-24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and another was lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73 m(2), while eGFR was 15-60 mL/min/1.73 m(2) in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.
authors.affiliation: Department of Paediatric Nephrology, Child Health 2 , Christian Medical College , Vellore , India.
authors.forename: Sudheer Kumar
authors.initials: SK
authors.lastname: Reddy
authors.affiliation: Department of Paediatric Nephrology , Christian Medical College , Vellore , India.
authors.forename: Afsana
authors.initials: A
authors.lastname: Jahan
authors.affiliation: Department of Paediatrics , Khoo Teck Puat-National University Children's Medical Institute, National University Health System , Singapore , Singapore.
authors.forename: Swasti
authors.initials: S
authors.lastname: Chaturvedi
authors.affiliation: Department of Paediatric Nephrology, Child Health 2 , Christian Medical College , Vellore , India.
authors.forename: Indira
authors.initials: I
authors.lastname: Agarwal
keywords: acute kidney injury; children; end-stage kidney disease; plasmapheresis; therapeutic plasma exchange