title: Plasma Exchange as an Adjunctive Therapy for Crescentic IgA Nephropathy.
abstract: Crescentic IgA nephropathy (CreIgAN) has a poor prognosis despite aggressive immunosuppressive therapy. The efficacy of plasma exchange (PE) in CreIgAN is not well defined.
  
  
  
  Twelve patients with severe CreIgAN who received PE as addition to routine immunosuppressive therapy, followed for more than 6 months, were involved. Twelve matched historical controls who received immunosuppressive therapy alone were selected by propensity score matching. Renal survival, plasma IgA-IgG complex and active complement products were assessed.
  
  
  
  Nine men and 3 women received a median of 7 PE courses (range 5-10). Their baseline urine protein excretion rate was 5.8 (4.5-8.7) g/day, and their serum creatinine level was 705.3 ± 296.4 μmol/l. During a mean follow-up of 15.6 months (6-51 months), 6 of the 12 PE group patients were free of dialysis, while all the control patients were dialysis dependent (6 of 12 vs. 0 of 12, p = 0.014). In the PE group, dialysis had to be restarted for 1 patient owing to the development of severe pneumonia and pulmonary failure. PE was associated with a higher kidney survival rate (log rank test, p = 0.026) during follow-up. It also significantly decreased plasma IgA-IgG complex levels (pre-PE: 85.3 ± 25.9% vs. post-PE: 38.4 ± 12.4%, p < 0.001) and plasma and urinary active complement product levels, including C3a, C5a and soluble C5b-9. The latter levels remained low until the last follow-up.
  
  
  
  This study indicated that PE could increase renal recovery rates in severe CreIgAN.
authors.affiliation: Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Peking University, Ministry of Education, Beijing, China.
authors.forename: Xinfang
authors.initials: X
authors.lastname: Xie
authors.forename: Jicheng
authors.initials: J
authors.lastname: Lv
authors.forename: Sufang
authors.initials: S
authors.lastname: Shi
authors.forename: Li
authors.initials: L
authors.lastname: Zhu
authors.forename: Lijun
authors.initials: L
authors.lastname: Liu
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhao
authors.initials: Z
authors.lastname: Cui
authors.forename: Xin
authors.initials: X
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Yu
authors.forename: Fude
authors.initials: F
authors.lastname: Zhou
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Zhao
authors.forename: Hong
authors.initials: H
authors.lastname: Zhang
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D015926:Complement C3a / Q000652:urine; D015936:Complement C5a / Q000652:urine; D015938:Complement Membrane Attack Complex / Q000652:urine; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005922:Glomerulonephritis, IGA / Q000097:blood / Q000628:therapy* / Q000652:urine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects*; D010956:Plasmapheresis / Q000009:adverse effects*; D011379:Prognosis; D006435:Renal Dialysis; D014022:Tissue Survival; D016896:Treatment Outcome
chemical_list: D015938:Complement Membrane Attack Complex; D007166:Immunosuppressive Agents; D015926:Complement C3a; D015936:Complement C5a; D003404:Creatinine