Analysis of clinicopathology and plasmapheresis efficacy in patients with anti-glomerular basement membrane disease
10.3760/cma.j.issn.1001-7097.2011.04.003
- VernacularTitle:抗肾小球基底膜病临床病理及血浆置换疗效分析
- Author:
Lijun MOU
;
Limeng CHEN
;
Laimeng ZUO
;
Yubing WEN
;
Hang LI
;
Yon QIN
;
Mingxi LI
;
Jianling TAO
;
Wenling YE
;
Hong XU
;
Wei YE
;
Yang SUN
;
Xuemei LI
;
Xuewang LI
- Publication Type:Journal Article
- Keywords:
Glomerular basement membrane;
Plasma exchange;
Anti-glomerular basement membrane antibody;
Therapy;
Prognosis
- From:
Chinese Journal of Nephrology
2011;27(4):230-235
- CountryChina
- Language:Chinese
-
Abstract:
objective To analyze the clinicopathological features and prognosis of antiglomerular basement membrane(GBM)disease,and evaluate the efficacy and safety of double filtration plasmapheresis(DFPP). Methods A total of 35 hospitalized patients diagnosed as anti-GBM disease in our department were enrolled in the study.All the patients were divided into 3 groups according to the manifestations at admission.Group Ⅰ∶24 patients with severe pulmonary hemorrhage or rapidly progressive glomerulonephritis(RPGN)received pulse methylprednisolone with or without DFPP,and then followed by prednisone and CTX.Group Ⅱ∶5 patients without severe pulmonary hemorrhage and RPGN received prednisone and CTX.Group Ⅲ∶5 ESRD patients and 1 normal renal function patient did not receive immunosuppression therapy.Anti-GBM antibody titer of pre-and post-DFPP in 4 patients was measured consecutively,and removal rate was calculated.Results The mean age of all the patients was(41.1±16.6)years.Sixteen patients(45.7%)presented Goodpasture's syndrome.Eighteen patients(51.4%)had anti-GBM glomerulonephritis alone,whereas one suffered solely from pulmonary hemorrhage.20%patients had positive P-ANCA serology.54.2%crescentic glomerulonephritis and 7 with other glomerulonephritis were revealed by kidney biopsy in 24 patients.Patients in Group Ⅰ showed more severe manifestation at admission:higher Scr level,higher titer of anit-GBM antibody,greater percentage of crescents.Within the follow-up period,7 patients died and kidneys of 50%patients survived.No patient died in Group Ⅱ and Ⅲ.The elder age,anemia,higher Scr(＞300 μmol/L),oliguria or anuria,emergency hemodialysis at admission,and more glomerular sclerosis were predictors of poor prognosis.The anti-GBM antibody was negative after 4 to 6 sessions of DFPP.and the mean removal rate was 55%.During total 94 DFPP sessions,there was no unacceptable morbidity. Conclusions Different therapy strategy is necessary for anti-GBM disease with different clinical manifestations.DFPP is an effective and safe clearance way of anti-GBM antibody.
