Role of plasma exchange in RPGN treatment
Is there any role for plasma exchange in the therapy for RPGN?
Plasma exchange is thought to remove circulating pathogenic autoantibodies from the circulation.
Trials evaluating efficacy of plasma exchange for all causes of RPGN have included only small numbers of patients. However, plasma exchange is a safe procedure in experienced centers and may be an appropriate therapeutic modality for subsets of patients with RPGN, in view of the high risk of kidney failure with this syndrome.
The European Vasculitis Study Group published a randomized trial that demonstrated that adjunctive plasma exchange improved kidney outcomes in patients with severe kidney failure (serum creatinine >2.3 mg/dL) and active ANCA vasculitis.
In addition, the prompt initiation of plasma exchange and aggressive immunosuppression with corticosteroids and cyclophosphamide can be lifesaving in patients with ANCA vasculitis and diffuse alveolar hemorrhage. Patients who are dialysis-dependent with ANCA vasculitis can respond to treatment.
Plasma exchange and immunosuppressive therapy are standard treatments for patients with anti-GBM antibody disease.
Most evidence supporting the use of plasma exchange in anti-GBM-associated diseases is from case reports, although one small, randomized, controlled trial demonstrated a non-significant trend toward improved outcome in patients treated with plasma exchange.
Patients who are dialysis-dependent with anti-GBM disease are unlikely to respond to aggressive treatment, and the potential benefit of treatment does not outweigh the risk in these individuals