Therapeutic apheresis in nephrology

Therapeutic plasma exchange (TPE) with hollow fiber modules is used in different severe diseases since more than 35 years. Based on many years of experience with the extracorporeal circulation in end-stage renal disease, the authors try to give an overview of therapeutic apheresis (TA) in renal diseases. The updated information on immunology and molecular biology of different renal diseases are discussed in relation to the rationale for apheresis therapy and its place in combination with other modern treatments. The different renal diseases can be treated by various apheresis methods such as TPE with substitution solution, or with online plasma or blood purification using adsorption columns which contain biological or non biological agents. The following diseases are discussed: rapidly progressive glomerulonephritis (RPGN) including anti-glomerular basement membrane antibody glomerulonephritis (anit-GBM RPGN), RPGN with or without glomerular deposition (ANCA-ab), pauci-immune RPGN, immune complex nephritis (ICN), and various glomerulonephritis with nephrotic syndrome (NS), hemolytic-uremic syndrome (HUS), myoglobulinemic renal failure, acute kidney injury (AKI), and kidney transplant rejection. For the renal diseases which can be treated with TA the guidelines of the Apheresis Applications Committee (AAC) of the American Society for Apheresis (ASFA) are cited.