PLASMAPHERESIS IN TREATMENT OF ACUTE OLIGOANURIA IN CRESCENTIC GLOMERULONEPHRITIS

Plasmapheresis therapy can provide an approach in the treatment of cre scentic glomerulonephritis by mechanically removing nephritogenic fact ors from the circulation, both antiglomerular basement membrane antibo dies and circulating immune complexes as well as antineutrophil cytopl asmic antibodies (ANCAs), We present our experience with plasmapheresi s treatment in patients with acute oligoanuria caused by crescentic gl omerulonephritis. We used membrane plasmapheresis to treat 11 patients with crescentic glomerulonephritis with more than 80% crescent format ion on biopsy and with acute onset of the disease and acute oligoanuri a. The immune complex form of the disease was documented in 7, the ant iglomerular basement membrane antibodies mediated (anti-GBM) form in 2 , the ANCA-associated form in 1 case, and the recurrent anti-GEM form in 1 patient. Plasmapheresis was performed 2-3 times weekly using Bell co BL 500 and Gambro 2000 PF plasma filters. The total number of plasm a exchanges (2,000-2,200 ml each) for each patient was 5-9. The treatm ent was associated with steroids and cyclophosphamide. The improvement of renal function with the start of diuresis and significant decrease of creatinine from the range of 786-1,301 mu M at the start of the tr eatment was noted in 5 of the 11 patients. The duration of remission w ithout hemodialysis was 6-12 months. Treatment with plasmapheresis in cases with recurrent anuria was without benefit. We can conclude that plasmapheresis can delay end-stage renal failure in cases with acute o nset of crescentic glomerulonephritis.