アフェレシスは腎不全の進行を抑制するか

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  • Does Apheresis in Renal Disorders Affect Prognosis?

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Apheresis has preventional effects for the progression of some renal diseases, such as focal glomerular sclerosis (FGS), lupus nephritis (LN), Cryoglobulinemia, Goodpasture's syndrome, anti-neutrophic cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN), thrombotic thrombocytopenic purpura (TTP), hemolitic uremic syndrome (HUS), myeloma and renal allograft reiection. There are several reports that LDL-apheresis is one of the therapeutic tools to induce remission in patients with steroid-resistant FGS. Plasma exchange (PEx) has been useful in the treatment of rapidly progressive or acute onset LN. PEx has also been helpful with cryoglobulinemia. Goodpasture's syndrome, and ANCA-associated GN in patients with steroid-immunosuppression-resistant renal disease. The hyperviscosity syndrome which is complicated these diseases is best treated by PEx. Cryofiltration has also been indicated for cryoglobulinemia. Renal disease in TTP is usually mild. HUS is a disorder closely related to TTP, but differs in that the kidney appears to be the major target. PEx is a secondary treatment modality for HUS as compared to being the primary treatment modality for TTP. Therapy of myeloma kidney or renal injury of light-chain disease has been aimed at the use of PEx to attempt to remove paraproteins. Hypercalcemia, which is complicated with these diseases and induces renal iniury, has been treated with hemodialysis. It has been reported that PEx has preventive effects for acute reiection of renal transplantation by the removal of anti-donor antibody or anti-A/B antibodies.

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