Improved outcome in rapidly progressive glomerulonephritis by plasma exchange treatment

During the last 3.5 years we have had facilities to perform effective plasma exchange treatment (PE). During this period of time 12 patients of idiopathic and 19 patients of collagenous rapidly progressive glomerulonephritis (RPGN) appeared, Goodpasture's syndrome excluded. In an attempt to evaluate the separate effect of immunosuppression (IS) and PE, PE was if possible withheld for two weeks. In 3 patients IS alone had a satisfactory effect and therefore no PE was performed. In 2 severely ill patients IS and PE were instituted simultaneously. In 6 patients PE was started 5-12 days and in 17 patients at least 14 days after the start of IS. In 3 patients PE was started first because of suspected septicemia. 23 of the 31 patients improved; 6 from IS alone, 3 from IS and probably also from PE, 1 from PE and probably from IS, 5 both from IS and PE and 1 from PE alone. In 7 patients the individual effect of IS and PE could not be evaluated. At follow up 1-37 (median 13) months 13 patients had a S-creatinine below 200, 2 patients 200-300 and 1 patient 510 mumol/l. 3 patients went into RDT immediately and 7 after 4-22 months. 5 elderly patients died, only 1 from uremia, the others from cardiovascular diseases. The outcome was unpredictable from clinical and laboratory data. Addition of PE in the treatment of RPGN seems to have improved the outcome considerably.