Role of Plasmapheresis Performed in Hemodialysis Units for the Treatment of Anti-Neutrophilic Cytoplasmic Antibody-Associated Systemic Vasculitides

Anti‐neutrophilic cytoplasmic antibody (ANCA) positivity is seen in some systemic necrotizing vasculitides. Wegener's granulomatosis and microscopic polyangiitis are among the ANCA‐associated systemic vasculitides (AASV) and mortality is very high when renal failure occurs together with alveola...

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Veröffentlicht in:Therapeutic apheresis and dialysis 2011-10, Vol.15 (5), p.493-498
Hauptverfasser: Aydin, Zeki, Gursu, Meltem, Karadag, Serhat, Uzun, Sami, Tatli, Emel, Sumnu, Abdullah, Ozturk, Savas, Kazancioglu, Rumeyza
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container_end_page 498
container_issue 5
container_start_page 493
container_title Therapeutic apheresis and dialysis
container_volume 15
creator Aydin, Zeki
Gursu, Meltem
Karadag, Serhat
Uzun, Sami
Tatli, Emel
Sumnu, Abdullah
Ozturk, Savas
Kazancioglu, Rumeyza
description Anti‐neutrophilic cytoplasmic antibody (ANCA) positivity is seen in some systemic necrotizing vasculitides. Wegener's granulomatosis and microscopic polyangiitis are among the ANCA‐associated systemic vasculitides (AASV) and mortality is very high when renal failure occurs together with alveolar hemorrhage. The role of plasmapheresis in the treatment of these diseases has been studied retrospectively. Twelve patients with AASV who had plasmapheresis together with immunosuppressive medications have been involved. Primary diseases, immunosuppressive protocols, the number of plasmapheresis sessions, the amount of plasma that has been exchanged, urea and creatinine levels before and after treatment, pulmonary findings, the need for hemodialysis, and the outcome of patients were recorded. The mean age of patients was 52.9 ± 18.2 years. Wegener's granulomatosis was diagnosed in seven (58.3%) and microscopic polyangiitis in five (41.7%) patients. All patients had pulse cyclophosphamide and methylprednisolone followed by maintenance doses and plasmapheresis. Seven patients had hemodialysis at the beginning, and hemodialysis needed to be continued in three patients. Partial and complete remission was seen in 6 (50%) and 3 (25%) patients, respectively, and pulmonary findings regressed in all patients. End‐stage renal disease develops generally in AASV due to rapidly progressive glomerulonephritis causing severe irreversible glomerular damage. The mortality rate rises to 50% in cases of renal failure with diffuse alveolar hemorrhage; therefore, pulse immunosuppressive treatment with plasmapheresis may be life‐saving, as shown in our study.
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Wegener's granulomatosis and microscopic polyangiitis are among the ANCA‐associated systemic vasculitides (AASV) and mortality is very high when renal failure occurs together with alveolar hemorrhage. The role of plasmapheresis in the treatment of these diseases has been studied retrospectively. Twelve patients with AASV who had plasmapheresis together with immunosuppressive medications have been involved. Primary diseases, immunosuppressive protocols, the number of plasmapheresis sessions, the amount of plasma that has been exchanged, urea and creatinine levels before and after treatment, pulmonary findings, the need for hemodialysis, and the outcome of patients were recorded. The mean age of patients was 52.9 ± 18.2 years. Wegener's granulomatosis was diagnosed in seven (58.3%) and microscopic polyangiitis in five (41.7%) patients. All patients had pulse cyclophosphamide and methylprednisolone followed by maintenance doses and plasmapheresis. 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subjects Adult
Aged
Aged, 80 and over
Anti-neutrophilic cytoplasmic antibody
Combined Modality Therapy
Cyclophosphamide - administration & dosage
Cyclophosphamide - therapeutic use
Female
Follow-Up Studies
Granulomatosis with Polyangiitis - therapy
Humans
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - therapeutic use
Male
Methylprednisolone - administration & dosage
Methylprednisolone - therapeutic use
Microscopic polyangiitis
Microscopic Polyangiitis - therapy
Middle Aged
Plasmapheresis - methods
Pulse Therapy, Drug
Remission Induction
Renal Dialysis - methods
Retrospective Studies
Treatment Outcome
Vasculitis
Wegener's granulomatosis
Young Adult
title Role of Plasmapheresis Performed in Hemodialysis Units for the Treatment of Anti-Neutrophilic Cytoplasmic Antibody-Associated Systemic Vasculitides
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