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Related Experiment Videos

Apheresis in lupus nephritis.

N Mistry-Burchardi1, U Schönermarck, W Samtleben

  • 1Department of Internal Medicine, Grosshadern, Ludwig Maximilians University, Munich, Germany. n.mistry-burchardi@lrz.uni-muenchen.de

Therapeutic Apheresis : Official Journal of the International Society for Apheresis and the Japanese Society for Apheresis
|July 27, 2001
PubMed
Summary

Plasma exchange offers no clear benefit for lupus nephritis. Selective antibody adsorption shows promise but requires further research for lupus nephritis treatment recommendations.

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Area of Science:

  • Nephrology
  • Immunology
  • Rheumatology

Background:

  • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease frequently affecting the kidneys, leading to lupus nephritis.
  • Despite advancements in immunosuppressive therapy, renal failure remains a significant cause of morbidity and mortality in SLE patients.
  • Pathogenesis of lupus nephritis involves autoantibodies, suggesting extracorporeal removal as a potential therapeutic strategy.

Purpose of the Study:

  • To evaluate the efficacy of extracorporeal autoantibody removal techniques, including plasma exchange and immunoadsorption, in treating lupus nephritis.
  • To determine if these methods offer benefits beyond conventional immunosuppressive therapy for lupus nephritis management.

Main Methods:

  • Review of currently available studies on plasma exchange (PE) as monotherapy or adjunct to immunosuppression for active lupus nephritis.

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  • Assessment of preliminary clinical trials investigating immunoadsorption column efficacy in lupus nephritis.
  • Analysis of the rationale for selective immunoglobulin removal versus non-selective plasma removal.

    • Main Results:

    • Plasma exchange, alone or with standard immunosuppression, showed no clear benefit for active lupus nephritis and is not recommended.
    • Plasmapheresis may have a role in acute, life-threatening cases or for non-responders to conventional therapy, though not proven.
    • Immunoadsorption offers selective removal of immunoglobulins, a potentially more rational approach, with promising initial trial results.

    Conclusions:

    • Current evidence does not support the routine use of plasma exchange for lupus nephritis.
    • Immunoadsorption shows potential for lupus nephritis treatment, but requires well-designed, controlled studies to confirm efficacy and cost-effectiveness.
    • Definitive recommendations on immunoadsorption protocols (column type, intensity, duration, concurrent immunosuppression) for lupus nephritis are pending further research.