Abstrait

Therapeutic apheresis in immunocomplex nephritis: A case report of a successful treatment.

Rolf Bambauer, Ralf Schiel

The advantages of the Therapeutic Apheresis (TA) with membrane modules, which became available since the mid-1970s, are a complete separation of the blood cells from the plasma. Autoimmune diseases have an immune pathogenesis and can produce auto antibodies (ab) and Circulating Immune Complexes (CIC), which are the origin of inflammation in various organs. The most patients with these diseases have a poor prognosis without treatment. TA in combination with immunosuppressive drugs has brought an increase in the survival rates over the last 40 years. The origin of autoimmune diseases is still generally unknown. The variety of autoimmune diseases ranges from those diseases in which autoimmunization is solely responsible for the condition (e.g., autoimmune hemolytic anemia) to those in which it possibly has a major influence on the course of the disease (e.g., rheumatoid arthritis), and those in which the autoimmunization results are probably only of diagnostic importance. The auto antibodies (auto-abs) activate different immunological processes which are self-destructive for the organs. These auto antibodies can be directed to all blood cells, too. With a case report of a woman, who was treated with Therapeutic Plasma Exchange (TPE) intermittently since her childhood, the authors show the efficacy of TPE in autoimmune diseases. The patients have had immunocomplex nephritis with a severe nephrotic syndrome which was diagnosed by a renal biopsy in the age of 14 months of the child. In the now more than 30 years old woman acute attacks of immunocomplex nephritis with nephrotic syndrome could be well controlled by TPE without excessive increases in the dosage of immunosuppressive drugs and a significant impairment in renal function.