title: [Plasma exchange in nephrology: Indications and technique].
abstract: Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Compensation by viro-attenuated plasma is reserved solely for the treatment of thrombotic microangiopathies or when there is a risk of bleeding, because this product is very allergenic and expensive. The treatment goal for a plasma exchange session should be between one and one and one-half times the patient's plasma volume estimated at 40 mL/kg body weight. The anticoagulation is best ensured by the citrate. Complications of plasma exchange are quite rare according to the French hemapheresis registry. The level of evidence of efficacy of plasma exchange in nephrology varies from one pathology to another. Main indications of plasma exchange in nephrology are Goodpasture syndrome, antineutrophil cytoplasmic antibody vasculitis when plasma creatinine is greater than 500 μmol/L, and thrombotic microangiopathies. During renal transplantation, plasma exchange may be proposed in the context of human leukocyte antigen (HLA) desensitization protocols or ABO-incompatible graft. After renal transplantation, plasma exchange is indicated as part of the treatment of acute humoral rejection or recurrent focal segmental glomerulosclerosis on the graft. Plasma exchanges are also proposed in the management of cryoglobulinemia or polyarteritis nodosa. Hemodialysis with membranes of very high permeability tends to replace plasma exchange for myeloma nephropathy. The benefit from plasma exchange has not been formally demonstrated for the treatment of severe lupus or antiphospholipid antibody syndrome. There is no indication of plasma exchange in the treatment of scleroderma or nephrogenic systemic fibrosis. More selective apheresis techniques such as immunoadsorption are currently proposed to replace plasma exchange.
authors.affiliation: Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. Electronic address: christophe.ridel@aphp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Ridel
authors.affiliation: Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Service de néphrologie et hypertension, centre hospitalier universitaire vaudois (CHUV), 21, rue du Bugnon, 1011 Lausanne, Suisse.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Kissling
authors.affiliation: Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mesnard
authors.affiliation: Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Hertig
authors.affiliation: Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
authors.forename: Éric
authors.initials: É
authors.lastname: Rondeau
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D003102:Colloids; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D010951:Plasma Exchange / Q000379:methods
chemical_list: D000925:Anticoagulants; D003102:Colloids
keywords: Apheresis; Aphérèse; Immunoadsorption; Immunoadsorption therapy; Plasma; Plasma exchange; Soluté de substitution; Substitution solute; Échange plasmatique