Plasmapheresis experience in patients with acute kidney injury

Objective: Plasmapheresis has been used in the management of immune-mediated renal diseases for the last 40 years. The rationale behind this approach is to remove pathogenic immune mediators, such as autoantibodies and immune complexes, from the circulation. In this study, we aimed to evaluate retrospectively the patients treated with plasmapheresis in our clinic.
Material and Method: A total of 27 patients who had been hospitalized and treated in our clinic in the last 10 years were evaluated. Demographic characteristics, biochemical parameters, biopsy results, plasmapheresis complications and survival analyses following treatments were recorded.
Results: The mean age of the patients was 39±18 (17-71) years and the mean number of plasmapheresis sessions was 13.9±8.8 (2-41). Six patients had Goodpasture Syndrome, 5 patients had ANCA (+) small vessel vasculitis, 5 patients had thrombotic microangiopathy, 4 patients had Systemic Lupus Erythematosus, 3 patients had Acute Humoral Rejection, 3 patients had primary crescentic glomerulonephritis and 1 patient had multiple myeloma. One patient died, 9 patients had renal improvement and 12 patients underwent dialysis due to end stage renal disease during the treatment. One patient with renal improvement experienced recurrence, and including this patient, Grade 2-3 renal failure continued in a total of 6 patients.
Conclusion: In conclusion, plasmapheresis should be considered as an adjuvant treatment in some specific groups in Nephrology Clinics. It can prevent progression to end stage renal failure and accelerate renal improvement.

Akut böbrek hasarlý hastalarda plazmaferez tecrübesi

Amaç: Plazmaferez, immunolojik renal hastalýklarýn tedavisinde son 40 yýldýr kullanýlmaktadýr. Bu yaklaþýmýn altýnda yatan mekanizma antikorlar ve immun kompleksler gibi patojenik immun mediatörlerin dolaþýmdan temizlenmesidir. Bu çalýþmada kliniðimizde plazmaferez tedavisi gören hastalarýn retrospektif olarak deðerlendirilmesi amaçlanmýþtýr.
Gereç ve Yöntemler: Son 10 yýlda kliniðimizde yatan ve terapötik plazmaferez tedavisi alan toplam 27 hastanýn kayýtlarý deðerlendirildi. Demografik özellikleri, biyokimyasal parametreleri, biyopsi sonuçlarý, plazmaferez komplikasyonlarý ve tedavisi sonrasý saðkalýmlarý kayýt edildi.
Bulgular: Hastalarda ortalama yaþ 39±18 (17-71) yýl, ortalama plazmaferez seans sayýsý 13.9±8.8 (2-41) olarak saptandý. Altý hastada Goodpasture hastalýðý, 5 hastada ANCA (+) küçük damar vasküliti, 5 hastada trombotik mikroanjiyopati, 4 hastada sistemik lupus eritematozus, 3 hastada akut humoral rejeksiyon, 3 hastada primer kresentik glomerulonefrit ve 1 hastada ise multipl myelom saptandý. Tedavi esnasýnda bir hasta exitus oldu, 9 hastada renal iyileþme görüldü, 12 hastada son dönem böbrek yetmezliði nedeniyle diyaliz tedavisine baþlandý. Renal düzelme saptanan hastalardan birinde nüks saptandý ve bu hasta ile birlikte toplam 6 hastada da Evre 2-3 böbrek yetmezliði devam etti.
Sonuç: Plazmaferez nefroloji kliniklerinde bazý özel grup hastalarda adjuvan tedavi olarak düþünülmelidir. Son dönem böbrek yetmezliðine ilerlemeyi önleyebilir ve renal iyileþmede hýzlanmaya neden olabilir.