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Keywords = PEXIVAS

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8 pages, 689 KB  
Perspective
Should We Still Use Therapeutic Plasma Exchange for Rapidly Progressive Glomerulonephritis in ANCA Associated Vasculitis?
by Andre A. Kaplan and Wladimir M. Szpirt
Kidney Dial. 2022, 2(3), 399-406; https://doi.org/10.3390/kidneydial2030035 - 5 Jul 2022
Cited by 5 | Viewed by 7908
Abstract
For over thirty-five years, available data suggested that therapeutic plasma exchange (TPE) was a useful treatment for patients with Rapidly Progressive Glomerulonephritis (RPGN) associated with ANCA Associated Vasculitis (AAV) and elevated creatinine levels. The publication of the PEXIVAS study has challenged this conclusion. [...] Read more.
For over thirty-five years, available data suggested that therapeutic plasma exchange (TPE) was a useful treatment for patients with Rapidly Progressive Glomerulonephritis (RPGN) associated with ANCA Associated Vasculitis (AAV) and elevated creatinine levels. The publication of the PEXIVAS study has challenged this conclusion. This perspective will outline the history of this issue and present our assessment of the current status. Full article
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9 pages, 244 KB  
Review
Plasma Exchange in ANCA-Associated Vasculitis: A Narrative Review
by Stathis Tsiakas, Smaragdi Marinaki, Sophia Lionaki and John Boletis
J. Clin. Med. 2021, 10(21), 5154; https://doi.org/10.3390/jcm10215154 - 3 Nov 2021
Cited by 8 | Viewed by 4890
Abstract
Therapeutic plasma exchange (TPE) is an adjunctive intervention to immunosuppression for the treatment of severe renal involvement or lung hemorrhage in patients with ANCA-associated vasculitis (AAV). Patients with AAV have an increased risk for progression to end-stage kidney disease (ESKD) or death despite [...] Read more.
Therapeutic plasma exchange (TPE) is an adjunctive intervention to immunosuppression for the treatment of severe renal involvement or lung hemorrhage in patients with ANCA-associated vasculitis (AAV). Patients with AAV have an increased risk for progression to end-stage kidney disease (ESKD) or death despite advances in immunosuppressive therapy. The potential pathogenicity of ANCA makes TPE a reasonable treatment approach for the life-threatening complications of AAV. The efficacy of intensive TPE in rapidly progressive glomerulonephritis was originally described in small studies almost four decades ago. Further randomized trials examined the addition of TPE to standard of care, exhibiting mixed results in both patient and renal survival. The largest clinical trial to date, PEXIVAS, failed to demonstrate a clear benefit for TPE in severe AAV. In light of new evidence, the role of TPE remains controversial across the vasculitis medical community. The purpose of this review is to summarize the clinical indications and the current available data for the use of TPE in patients with severe AAV. Full article
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