Therapeutic plasmapheresis in patients with renal disease

Therapeutic plasmapheresis has been enthusiastically applied in recent years to a number of disease entities associated with renal failure. It seems reasonable to attempt removal of intravascular macroglobulins or immune complexes by this mechanism; however, multiple modalities of therapy are often employed virtually simultaneously, confounding the delineation of successful treatment. Two case reports are presented to illustrate the lack of immediate response to pheresis in patients receiving other modalities of treatment. It is clear that controlled clinical trials are needed to define better the usefulness of plasmapheresis in renal diseases.