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Plasma exchange in the treatment of mesangiocapillary glomerulonephritis
Insights
Regular plasma exchange may halt kidney failure progression in mesangiocapillary glomerulonephritis type I (MCGN-I). This treatment showed no benefit for other glomerulopathies, but was safe for up to 44 months.
Area of Science:
- Nephrology
- Immunology
- Internal Medicine
Background:
- Primary glomerulopathies can lead to slowly progressive renal failure.
- Mesangiocapillary glomerulonephritis (MCGN) encompasses various subtypes with different prognoses.
- Current treatments for progressive renal failure in glomerulopathies are limited.
Purpose of the Study:
- To evaluate the efficacy of regular plasma exchange (PE) in patients with primary glomerulopathies and progressive renal failure.
- To determine if PE can prevent the progression of renal failure in specific glomerulonephritis subtypes.
- To assess the safety and duration of PE therapy.
Main Methods:
- Nine patients with primary glomerulopathies and progressive renal failure were treated with regular 2.8-litre plasma exchanges.
- No immunosuppressive drug therapy was administered concurrently.
- Treatment duration varied, with some patients undergoing PE for up to 44 months.
Main Results:
- All three patients with subendothelial mesangiocapillary glomerulonephritis (MCGN-I) showed no progression of renal failure during PE.
- Renal function declined upon cessation of PE and improved in two patients upon restarting treatment.
- Patients with hypocomplementaemic dense deposit disease (MCGN-II) and idiopathic membranous nephropathy (IMN) did not benefit from PE.
- One patient with normocomplementaemic MCGN-II experienced temporary improvement.
- Proteinuria decreased or remained stable in improving patients during the first month of PE.
Conclusions:
- Regular plasma exchange appears to prevent the progression to renal failure in patients with MCGN-I.
- The efficacy of PE may be specific to MCGN-I, as other glomerulopathies did not show benefit.
- Plasma exchange using immunoalbumin was safe and well-tolerated for extended periods.
Abstract:
9 patients with primary glomerulopathies and slowly progressive renal failure were treated by regular plasma exchanges without immunosuppressive drug therapy. All 3 patients with the subendothelial type of mesangiocapillary glomerulonephritis (MCGN-I) had no progression of their renal failure while undergoing plasma exchanges. The creatinine rose when treatment was stopped and fell again in 2 patients who restarted plasma exchange. 2 patients with hypocomplementaemia and dense deposit disease (MCGN-II) and all 3 patients with idiopathic membranous nephropathy (IMN) did not benefit. 1 patient with normo-complementaemic MCGN-II had some improvement in renal function which lasted 18 months. Proteinuria fell or was unchanged during the 1st month of plasma exchange in the 4 who improved and increased in the 5 who did not. The response to plasma exchanges could not be attributed to removal of circulatory complexes or changes in reticulo-endothelial function. Regular 2.8-litre plasma exchanges using 4.3% immunoalbumin proved to be safe for periods up to 44 months. Regular plasma exchange appears to prevent progression to renal failure in patients with MCGN-I.