POS-513 PLASMA EXCHANGE IN NEPHROLOGY

Abstract

Plasma exchange is a therapeutic tool with broad indications in different diseases. The aim of this study was to determine its indications and possible complications in the nephrology setting. This is a retrospective study of therapeutic plasma exchange performed in our department over 15 years [2006 to 2021]. Our study included 20 patients with an average age of 46.45 years [18-77] and a sex ratio of 0.66. The initial symptomatology was variable. A glomerular syndrome was present in all patients associated with rapidly progressive renal failure in 15 cases with an average blood creatinine level of 645.05 µmol/L [144-2017], 12 cases of Haemoptysis on chest CT scan or bronchoalveolar lavage and one case of cerebellar syndrome. Immunologically, 7 cases were positive for antiGBM antibodies, 4 cases positive for anti-MPO antibodies, 3 cases positive for antiPR3 antibodies, and serum complement was consumed in 3 patients. Renal biopsy performed in 10 patients revealed 1 case of myeloma nephropathy, 2 cases of lupus nephropathy, 3 cases of vasculitis, and 4 cases of Goodpasture's disease. Indications were diverse and included rapidly progressive glomerulonephritis, acute humoral rejection in a renal transplant patient, hyperviscosity syndrome in a myeloma patient, and a case of acute polyradiculoneuritis. The products used were albumin with fresh frozen plasma in all patients and albumin alone for the renal transplant patient, with an exchange volume of 50cc/kg. The average number of sessions was 6.3 [1-16] with a frequency of 1 to 3 sessions per week. Complications ranged from 2 episodes of circuit clotting to 2 episodes of low blood pressure, one case of acute coronary syndrome, one case of seizure followed by cardiac arrest and death. The progression was marked by an improvement of the renal function in 8 patients, the use of extrarenal purification in 9 patients, and the death of 2 patients. The indications for therapeutic plasma exchange are increasingly broad in the nephrology setting, including neurological and hematological disorders in patients with various kidney diseases.