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Background: A patient suffering from HSP nephritis and acute renal failure had kidney function improved, serum creatinine stabilized at 1.2mg/dl after treatment by blood plasma exchange, and the report is published on Clinical Kidney Journal.
Henoch-schonlein Purpura Nephritis (HSP) is a micro-vascular leukocytoclastic vasculitis characterized by the deposition of immune complexes containing IgA. The immune complexes will trigger abnormal inflammations and damage functioning renal intrinsic cells. Plasma exchange, or plasmapheresis, is a procedure that removes plasma from the blood and replaces it with new plasma fluid. In this process, the harmful immune complexes circulating in the blood can be removed. In this way, it is expected that progressive inflammations can be slowed down and Henoch-schonlein Purpura Nephritis (HSP) can be alleviated or well controlled.
Henoch-Schonlein Purpura (HSP) frequently occurs in children under 15 years old but is quite rarely seen in adults. Most children who develop HSP nephritis completely recover from the illness, whereas up to 40% of adults have persistent hematuria and 10% develop chronic renal failure. Clinically, those manifested as acute nephritis and with presence of massive crescents have great risk of developing kidney failure. For those patients, more active treatment besides steroid treatment may be applied, such as blood plasma exchange treatment. In clinical trials, combination of blood plasma exchange on Henoch-Scholein Purpura Nephritis patients have proven therapeutic effects in remitting clinical manifestations and slowing down renal progressions.
In a recent case, a 59-year-old white male developed HSP nephritis developed acute renal failure with proteinuria and hematuria ∼2 weeks after being initially diagnosed with HSP by skin biopsy. Renal biopsy indicated proliferative glomerulonephritis involving all 20 glomeruli and immunofluorescence staining showed 3+ IgA deposits in mesangium suggesting HSP-induced GN. Creatinine rose over 2.5 mg/dl and 24h protein 5 even if steroids were adopted. Blood plasma exchange was performed on the patient. Subsequently, kidney function was improved and creatinine level was lowered to 1.3 mg/dl. In further check-ups, creatinine stayed at 1.2 mg/dl and there was trace proteinuria while taking a low-dose ACE inhibitor.
In another study, a 79-year-old man had allergic purpura nephritis, and had 24h protein 2.0g, blood in urine 3+ and serum creatinine 1.2mg/dl. Prednisolones and methlprednisolones were given, without any improvement in kidney function and urinary findings. A further blood plasma exchange is then operated, showing an improvement of kidney function. Creatinine was reduced from 2.7 to 0.8 mg/dl and proteinuria decreases from 3.7 to 0.1g/d. Biopsy after the treatment suggests that dense deposits disappeared. The above findings provide proof for the effectiveness of blood plasma exchange in treatment of HSP Nephritis.
Blood plasma exchange as an advanced technique holds promise for controlling progression of HSP and improving prognosis in the patients. To learn more about blood plasma exchange, you may read blood purification technique part on this website, or you are welcome to contact us for free.
