Therapeutic Plasma Exchange in Renal Disorders
D Ranganathan1,2, G T John1,3
1Department of Renal Medicine, Metro North Hospital and Health Services, Herston, India.
Indian Journal of Nephrology
|May 31, 2019
Summary
Therapeutic plasma exchange (TPE) removes large molecules like antibodies from plasma, proving effective for various kidney diseases, including transplant rejection and glomerulonephritis. This review covers TPE methods, rationale, and potential complications in nephrology.
Area of Science:
- Nephrology
- Immunology
- Renal Medicine
Background:
- Hemodialysis and hemofiltration clear small toxins.
- Therapeutic plasma exchange (TPE) removes larger molecules like immunoglobulins and immune complexes.
- TPE is increasingly utilized in managing complex renal disorders.
Purpose of the Study:
- To review different modalities of TPE.
- To discuss the application, rationale, and complications of TPE in renal disorders.
- To highlight evidence-based recommendations for TPE use in specific nephrological conditions.
Main Methods:
- Review of existing literature on TPE modalities and their use in nephrology.
- Discussion of specific renal diseases where TPE is indicated.
- Exploration of modifications to TPE, such as double membrane filtration and immune adsorption.
Main Results:
- TPE is evidence-based for antibody-mediated renal diseases, including transplant rejection and glomerulonephritis (GN).
- Specific indications include anti-glomerular basement membrane GN, ANCA-associated GN, and antibody-mediated thrombotic thrombocytopenic purpura.
- The use of TPE is expanding to other renal conditions.
Conclusions:
- TPE is a valuable therapeutic option for specific antibody-mediated renal diseases.
- Modifications like immune adsorption enhance TPE's efficacy.
- Further research supports the expanding role of TPE in nephrology.
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