What is the role of plasmapheresis in anti-glomerular basement membrane (GBM) disease?
In anti-GBM disease, the role of plasmapheresis is the rapid removal of the pathogenic antibodies. Plasmapheresis in combination with cyclophosphamide (blocks additional antibody production) and corticosteroids (reduces inflammation) may prevent kidney failure. All patients with anti-GBM antibody disease and severe kidney failure who do not require immediate dialysis should be treated with aggressive immunosuppression and intensive plasmapheresis. Plasmapheresis should be initiated in patients with pulmonary hemorrhage regardless of the severity of the kidney failure. However, patients presenting with dialysis dependence only had 8% kidney survival, and if the kidney biopsy showed crescentic lesions in all glomeruli, kidney survival was 0%. Plasmapheresis is usually done for 14 days or until the anti-GBM antibody is no longer detectable.