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[Effect of plasma exchange therapy on IgA nephropathy in children--a retrospective study]
1Department of Pediatric Nephrology, Tokyo Women's Medical College, Japan.
Insights
Plasma exchange therapy (PEx) shows limited efficacy for IgA nephropathy with advanced glomerulosclerosis in children. However, PEx may be effective when initiated during the acute phase of glomerulonephritis.
Area of Science:
- Pediatric Nephrology
- Immunology
- Renal Medicine
Background:
- IgA nephropathy (IgAN) is a common cause of glomerulonephritis in children.
- Plasma exchange therapy (PEx) is a treatment modality used for various autoimmune and kidney diseases.
- The efficacy of PEx in pediatric IgAN, particularly in severe cases, requires further investigation.
Observation:
- This study evaluated PEx in 17 children with severe IgA nephropathy.
- Proteinuria levels post-PEx were higher compared to non-PEx treated patients.
- Creatinine clearance (Ccr) improved in the first 6 months, but serum immunoglobulin and complement levels showed transient changes.
Findings:
- PEx did not demonstrate adequate efficacy in IgAN cases with advanced glomerulosclerosis.
- A significant proportion of patients (57.1%) progressed to chronic renal failure (CRF) within 2 years.
- PEx showed potential effectiveness when initiated during the acute clinical phase of glomerulonephritis.
Implications:
- PEx is not recommended for IgA nephropathy with advanced glomerulosclerosis in pediatric patients.
- Early intervention with PEx during the acute stage of IgAN may offer therapeutic benefits.
- Further research is needed to define the optimal role and timing of PEx in pediatric IgAN management.
Abstract:
Clinical and pathological analyses were performed to evaluate plasma exchange therapy (PEx) in children with severe IgA nephropathy. Values for PEx were obtained in 17 cases (male 13, female 4, 12.2 +/- 4.3 [M +/- SE] years old), whose proteinuria and creatinine clearance (Ccr) were 4.6 +/- 1.8 g/day and 64.4 +/- 31.3 ml/min/1.73 m2, respectively, immediately prior to treatment. Values for proteinuria in children after PEx were significantly higher than those of 151 cases of IgA nephropathy who were not treated by PEx in our unit. Ccr in patients who underwent PEx significantly improved during the first 6 months, whereas serum IgG, IgA and C3 levels returned to pre-PEx levels following a transient reduction at one month. Fourteen out of 17 cases were followed for more than 2 years. Among these patients, 8 (57.1%) progressed to chronic renal failure (CRF, Ccr < 30 ml/min/1.73 m2), and 6 showed improvement in Ccr (non-CRF, Ccr > or = 30 ml/min/1.73 m2). In 4 of these cases, PEx was introduced at an acute clinical phase of glomerulonephritis. Compared to 8 patients with progression (CRF), initial renal histology in these 6 patients revealed a lower percentile of glomerular sclerosis index (GSI) and had a significantly higher percentile of cellular crescents. These results suggest that: 1) PEx is not an adequate method of treatment of IgA nephropathy with advanced glomerulosclerosis, 2) PEx is effective in the acute stage of IgA nephropathy.