TY - JOUR
T1 - Plasma exchange for paediatric kidney disease-indications and outcomes
T2 - A single-centre experience
AU - Reddy, Sudheer Kumar
AU - Jahan, Afsana
AU - Chaturvedi, Swasti
AU - Agarwal, Indira
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background: Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. Objectives: We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. Methods: A retrospective chart reviewof children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchangewas undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis. Results: Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5-15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody-associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96-7.85] mg/dL with a mean eGFR of 43 (IQR 27.54-56.7) mL/min/1.73m2. Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5-26), dialysis and immunosuppressive therapy. The meanduration of follow-upwas 4 months (range 2-24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and anotherwas lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73m2, while eGFR was 15-60 mL/min/1.73m2 in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.
AB - Background: Outcome data in paediatrics regarding the use of plasmapheresis for immunological kidney disease are scarce. Objectives: We aimed to evaluate the role of plasmapheresis in children presenting with severe renal impairment secondary to immunological kidney diseases. Methods: A retrospective chart reviewof children admitted between January 2009 and August 2013 to the Paediatric Nephrology Unit, Christian Medical College, Vellore, India, and requiring plasma exchangewas undertaken. Demographic and clinical data were studied and descriptive statistics applied for analysis. Results: Sixteen children underwent plasmapheresis with a male:female ratio of 10:6 and a mean age of 10.2 years (range 5-15 years). Twelve children had atypical haemolytic uraemic syndrome, two had anti-glomerular basement disease and one each had lupus nephritis with neurological manifestation and anti-nuclear cytoplasmic antibody-associated vasculitis. The mean serum creatinine at presentation was 6.52 [interquartile range (IQR) 4.96-7.85] mg/dL with a mean eGFR of 43 (IQR 27.54-56.7) mL/min/1.73m2. Other presenting features included nephrotic range proteinuria (69%), gross haematuria (27%), hypertension (94%) and seizures (37.5%). All children received 1.5 times plasma volume plasmapheresis (mean 11 sessions, range 5-26), dialysis and immunosuppressive therapy. The meanduration of follow-upwas 4 months (range 2-24 months) with a majority of the children (15/16, 93.75%) surviving acute illness. One child died of overwhelming sepsis and anotherwas lost to follow-up. Of the survivors, eight had eGFR >60 mL/min/1.73m2, while eGFR was 15-60 mL/min/1.73m2 in the remaining six children. Eight children were still requiring antihypertensive medications and two were continuing peritoneal dialysis at the last follow-up. Thus early introduction of plasmapheresis along with other supportive therapy in immunological kidney disease may improve outcome.
KW - Acute kidney injury
KW - Children
KW - End-stage kidney disease
KW - Plasmapheresis
KW - Therapeutic plasma exchange
UR - http://www.scopus.com/inward/record.url?scp=84959375173&partnerID=8YFLogxK
U2 - 10.1093/ckj/sfv084
DO - 10.1093/ckj/sfv084
M3 - Article
AN - SCOPUS:84959375173
SN - 2048-8505
VL - 8
SP - 702
EP - 707
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 6
ER -