Échanges plasmatiques en néphrologie : techniques et indications [Plasma exchange in nephrology: Indications and technique]

Details

Serval ID
serval:BIB_A8353FD4BBDA
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Échanges plasmatiques en néphrologie : techniques et indications [Plasma exchange in nephrology: Indications and technique]
Journal
Nephrologie & therapeutique
Author(s)
Ridel C., Kissling S., Mesnard L., Hertig A., Rondeau É.
ISSN
1872-9177 (Electronic)
ISSN-L
1769-7255
Publication state
Published
Issued date
02/2017
Peer-reviewed
Oui
Volume
13
Number
1
Pages
43-55
Language
french
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Compensation by viro-attenuated plasma is reserved solely for the treatment of thrombotic microangiopathies or when there is a risk of bleeding, because this product is very allergenic and expensive. The treatment goal for a plasma exchange session should be between one and one and one-half times the patient's plasma volume estimated at 40 mL/kg body weight. The anticoagulation is best ensured by the citrate. Complications of plasma exchange are quite rare according to the French hemapheresis registry. The level of evidence of efficacy of plasma exchange in nephrology varies from one pathology to another. Main indications of plasma exchange in nephrology are Goodpasture syndrome, antineutrophil cytoplasmic antibody vasculitis when plasma creatinine is greater than 500 μmol/L, and thrombotic microangiopathies. During renal transplantation, plasma exchange may be proposed in the context of human leukocyte antigen (HLA) desensitization protocols or ABO-incompatible graft. After renal transplantation, plasma exchange is indicated as part of the treatment of acute humoral rejection or recurrent focal segmental glomerulosclerosis on the graft. Plasma exchanges are also proposed in the management of cryoglobulinemia or polyarteritis nodosa. Hemodialysis with membranes of very high permeability tends to replace plasma exchange for myeloma nephropathy. The benefit from plasma exchange has not been formally demonstrated for the treatment of severe lupus or antiphospholipid antibody syndrome. There is no indication of plasma exchange in the treatment of scleroderma or nephrogenic systemic fibrosis. More selective apheresis techniques such as immunoadsorption are currently proposed to replace plasma exchange.

Keywords
Anticoagulants/therapeutic use, Colloids, Humans, Kidney Diseases/therapy, Plasma Exchange/methods, Apheresis, Aphérèse, Immunoadsorption, Immunoadsorption therapy, Plasma, Plasma exchange, Soluté de substitution, Substitution solute, Échange plasmatique
Pubmed
Web of science
Create date
30/01/2017 20:05
Last modification date
11/06/2020 6:26
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