THERAPEUTIC IMMUNOADSORPTION IN GOODPASTU RES DISEASE

The extraction of circulating antiglomerular basement membrane (GEM) a ntibodies by plasmapheresis (PP) has allowed the prognosis of Goodpast ure's disease to markedly improve. Immunoadsorption (IA) may improve t he results of PP upon allowing more effective immunoglobulin extractio n. Two patients with Goodpasture disease were treated with IA. A rapid decrease was observed in the serum levels of anti GEM antibodies and improvement in respiratory failure. In one of the patients this regime n was administered following the observation of a lack of clinical res ponse of pulmonary hemorrhage in three PP sessions (9 liters of treate d plasma). In this patient, the IA processed 39 liters of plasma and t he method was found to be equally effective on reinstatement (29 liter s) on the occasion of a relapse in the pulmonary symptoms presented at three weeks after the first treatment. Both cases showed renal involv ement In one ease this was incipient and the treatment was associated with non progression of the kidney disease, normalization of the urine sediment and preservation of renal function. In the second case treat ment was initiated at an advanced disease state with no changes in dia lysis needs. Immunoadsorption has shown to be effective in the treatme nt of pulmonary hemorrhage in Goodpasture's disease. Onset of treatmen t at an early stage of the kidney disease may avoid progression to ren al-failure.