Plasma Exchange in ANCA-Associated Vasculitis: A Narrative Review

被引:3
|
作者
Tsiakas, Stathis [1 ]
Marinaki, Smaragdi [1 ]
Lionaki, Sophia [2 ]
Boletis, John [1 ]
机构
[1] Natl & Kapodistrian Univ Athens, Laiko Hosp, Clin Nephrol & Renal Transplantat, Sch Med, Athens 11527, Greece
[2] Natl & Kapodistrian Univ Athens, Attikon Hosp, Dept Internal Med 2, Sch Med, Athens 12462, Greece
关键词
plasma exchange; plasmapheresis; ANCA-associated vasculitis; kidney disease; review; RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS; TERM-FOLLOW-UP; CRESCENTIC GLOMERULONEPHRITIS; THERAPEUTIC APHERESIS; PLASMAPHERESIS; MANAGEMENT; METHYLPREDNISOLONE; GRANULOMATOSIS; POLYANGIITIS; HEMORRHAGE;
D O I
10.3390/jcm10215154
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Therapeutic plasma exchange (TPE) is an adjunctive intervention to immunosuppression for the treatment of severe renal involvement or lung hemorrhage in patients with ANCA-associated vasculitis (AAV). Patients with AAV have an increased risk for progression to end-stage kidney disease (ESKD) or death despite advances in immunosuppressive therapy. The potential pathogenicity of ANCA makes TPE a reasonable treatment approach for the life-threatening complications of AAV. The efficacy of intensive TPE in rapidly progressive glomerulonephritis was originally described in small studies almost four decades ago. Further randomized trials examined the addition of TPE to standard of care, exhibiting mixed results in both patient and renal survival. The largest clinical trial to date, PEXIVAS, failed to demonstrate a clear benefit for TPE in severe AAV. In light of new evidence, the role of TPE remains controversial across the vasculitis medical community. The purpose of this review is to summarize the clinical indications and the current available data for the use of TPE in patients with severe AAV.
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页数:9
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