Guidelines 2010 ASFA have produced a review of Plasma Exchange (PE) in renal therapy. In 2012 among kidney diseases Canadian Apheresis Group reported TTP/HUS as main indication for PE (63%); ANCA-vasculitides 14%, renal transplantation 10%, Goodpasture's syndrome 6% and FSGS post-transplantation 5%; cryoglobulinemia 2% and nephropathy myeloma <1% experienced drastic reduction of cases; no reports of SLE was reported.
We treated 19 patients with PE every 24–48 h for 2 weeks; sometimes more treatments (up to 26) were carried out. We chose a double lumen catheter for vascular access and sodium citrate for anticoagulation. Except in HUS (fresh frozen plasma), we used albumin as replacement fluid. The exchanged plasma volume was depending on body weight and Ht.
We treated: 3 Wegener Granulomatosis, 4 reno-pulmonary ANCA-vasculitides, 3 HUS, 2 cast-nephropathy multiple myeloma, 1 crescentic GN with brain involvement, 2 crescentic GN alone, 2 SLE; 1 patient with MPGN due to HCV-cryoglobulinemic vasculitis was treated 2 different times. PE were coupled with steroids and immunosuppressive therapy. All cases showed active bleeding, severe dyspnea, rapid progression of renal failure without favorable response to steroid treatment alone; 4 cases showed complete resolution of symptoms and normalization of renal function; 7 improved their clinical status without renal improvement; 5 improved both clinical status and renal function; 3 had fatal outcome. No complications of PE were described. The 3 patients dead, were suffering from: ANCA-vasculitis with severe brain and renal involvement, ANCA-vasculitis with pulmonary and renal involvement, sepsis with severe hematuria.
The 5 subjects with a favourable result, younger than other patients, were suffering from SLE (3) and ANCA-vasculitis (2). Rapid onset of drug treatment and PE, have produced a result successfully. In cases with fatal outcome, systemic involvement and late transfer have probably made ineffective drug therapy and PE.
