Plasmapheresis for crescentic IgA nephropathy: A report of two cases and review of the literature

Idiopathic IgA nephropathy is widely regarded as a slowly progressive disea se that not infrequently results in end-stage renal failure. Only a minorit y of patients present with either a rapidly progressive form of glomerulone phritis, or with end-stage renal failure. Anecdotal reports of improved ren al function after treatment with plasmapheresis have been published, but th e efficacy of this therapy remains controversial. We describe the course of two young males presenting with uremia, hypertension, nephrotic-range prot einuria, and crescentic glomerulonephritis on renal biopsy. Both patients u nderwent therapy with steroids, immunosuppressive agents, and plasmapheresi s without an appreciable improvement in renal function. A review of the lit erature does not offer any conclusive data to support the role of pIasmaphe resis in the treatment of rapidly progressive glomerulonephritis due to IgA nephropathy and points out the need to define criteria that may identify s ubsets of patients with this disorder who may potentially benefit from plas ma exchange therapy. J. Clin. Apheresis 14:185-187, 1999. Published 1999 Wi ley-Liss, Inc.dagger