Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption - PubMed (original) (raw)

Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption

Peter Biesenbach et al. PLoS One. 2014.

Abstract

Background: Anti-glomerular basement membrane (GBM) antibody disease may lead to acute crescentic glomerulonephritis with poor renal prognosis. Current therapy favours plasma exchange (PE) for removal of pathogenic antibodies. Immunoadsorption (IAS) is superior to PE regarding efficiency of antibody-removal and safety. Apart from anecdotal data, there is no systemic analysis of the long-term effects of IAS on anti-GBM-disease and antibody kinetics.

Objective: To examine the long-term effect of high-frequency IAS combined with standard immunosuppression on patient and renal survival in patients with anti-GBM-disease and to quantify antibody removal and kinetics through IAS.

Design: Retrospective review of patients treated with IAS for anti-GBM-antibody disease confirmed by biopsy and/or anti-GBM-antibodies.

Setting: University Hospital of Vienna, Austria.

Participants: 10 patients with anti-GBM-disease treated with IAS.

Measurements: Patient and renal survival, renal histology, anti-GBM-antibodies.

Results: Anti-GBM-antibodies were reduced by the first 9 IAS treatments (mean number of 23) to negative levels in all patients. Renal survival was 40% at diagnosis, 70% after the end of IAS, 63% after one year and 50% at the end of observation (mean 84 months, range 9 to 186). Dialysis dependency was successfully reversed in three of six patients. Patient survival was 90% at the end of observation.

Conclusion: IAS efficiently eliminates anti-GBM-antibodies suggesting non-inferiority to PE with regard to renal and patient survival. Hence IAS should be considered as a valuable treatment option for anti-GBM-disease, especially in patients presenting with a high percentage of crescents and dialysis dependency due to an unusual high proportion of responders.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1

Figure 1. Anti-GBM antibody levels from start of immunoadsorption until end of observation.

Mean values ± standard deviation of all patients measured with ELISA depicted. Grey area denotes negativity of the assay.

Figure 2

Figure 2. Anti-GBM antibody kinetics and renal function in patient #7 (2a) and patient #10 (2b).

Antibody values at diagnosis, before and after IAS, 12 hours in between sessions and up to 6 weeks; arrows depict daily IAS sessions. Grey area depicts negativity of the assay.

Figure 3

Figure 3. Dynamics of serum-creatinine of individual patients.

Observation period from start of IAS until 5 years. White coloured time points depict positive anti-GBM antibody testing.

Figure 4

Figure 4. Cumulative costs of immunoadsorption and plasma exchange.

Circles and triangles depict earliest timepoints of adsorber change due to reduced adsorption capacity (every 25 treatments for Immunosorba, every 35 treatments for Globaffin).

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