Plasma exchange (PLEX) is often included in the initial therapy of patients with antineutrophil cytoplasmic autoantibody-associated glomerulonephritis who present with severe kidney failure. However, new long-term follow-up data from the MEPEX trial suggest that PLEX may not improve survival in these patients.
References
Holle, J. U. & Gross, W. L. Treatment of ANCA-associated vasculitides (AAV). Autoimmun. Rev. 12, 483–486 (2013).
Walsh, M. et al. Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear. Kidney Int. http://dx.doi.org/10.1038/ki.2013.131.
Klemmer, P. J. et al. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am. J. Kidney Dis. 42, 1149–1153 (2003).
Jayne, D. R. et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J. Am. Soc. Nephrol. 18, 2180–2188 (2007).
Cole, E. et al. A prospective randomized trial of plasma exchange as additive therapy in idiopathic crescentic glomerulonephritis. The Canadian Apheresis Study Group. Am. J. Kidney Dis. 20, 261–269 (1992).
McGregor, J. G. et al. Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin. J. Am. Soc. Nephrol. 7, 240–247 (2012).
Lionaki, S. & Falk, R. J. Removing antibody and preserving glomeruli in ANCA small-vessel vasculitis. J. Am. Soc. Nephrol. 18, 1987–1989 (2007).
Pepper, R. J. et al. Intravenous cyclophosphamide and plasmapheresis in dialysis-dependent ANCA-associated vasculitis. Clin. J. Am. Soc. Nephrol. 8, 219–224 (2013).
Walsh, M. et al. Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis. Am. J. Kidney Dis. 57, 566–574 (2011).
Walsh, M. et al. Plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS): protocol for a randomized controlled trial. Trials 14, 73 (2013).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Bomback, A., Appel, G. ANCA-associated GN—to PLEX or not to PLEX?. Nat Rev Nephrol 9, 436–438 (2013). https://doi.org/10.1038/nrneph.2013.126
Published:
Issue Date:
DOI: https://doi.org/10.1038/nrneph.2013.126
- Springer Nature Limited