Filtration Rate Plasma Research Articles

Abstract P006: Purinergic Receptor Activation Protects Glomerular Microvasculature From Increased Mechanical Stress In Angiotensin Ii-induced Hypertension: A Modeling Study

Angiotensin II (Ang II)-induced hypertension increases afferent and efferent arteriole resistances via the actions of Ang II on the AT1 receptor. In addition to the increased interstitial levels of Ang II, the increased arterial pressure increases interstitial ATP concentrations which act on the purinergic receptors P2X1 and P2X7, to constrict the AA, preventing increases in plasma flow and single nephron GFR (SNGFR). Blockade of the P2 receptors also mitigates the effects of Ang II, thus increasing blood flow and SNGFR, but the resulting increases in mechanical stresses (shear stress and circumferential hoop stress) on the glomerular microvasculature have not been quantified. A mathematical microvascular hemodynamic glomerular model was developed to simulate blood flow and plasma filtration at each of 320 capillary segments in an anatomically-accurate rat glomerular capillary network topology. Afferent and efferent arteriole resistances and network hydraulic conductivity were adjusted to match glomerular hemodynamic data for control, Ang II-induced hypertension and P2X1-blocked conditions (Franco, Martha, et al. Amer. J. Physiology-Renal 313.1 (2017): F9-F19). Ang II infusion increased both afferent and efferent resistances, reducing blood flow while slightly raising glomerular pressure. Blockade of the purinergic receptors reduced both afferent and efferent resistances, maintaining glomerular pressure at hypertensive levels but increasing blood flow significantly, increasing shear stress from 24.9 dynes/cm 2 in hypertensive conditions to 71.3 dynes/cm 2 after purinergic blockade. Because glomerular pressure was maintained, hoop stress barely changed from 69.5 kPa in hypertensive conditions to 70.9 kPa after purinergic blockade. Purinergic blockade also increased hydraulic conductivity and filtering surface area, increasing SNGFR. In hypertension, purinergic stimulation does not prevent the transmission of increased arterial pressure to the glomerular capillaries to reduce capillary hoop stress. However, activation of the purinergic system protects the glomerular microvasculature from increases in shear stress caused by a marked increase in blood flow that would occur in the absence of purinergic stimulation.

Successful Desensitization by Post-Centrifugal Plasma Filtration in Two Highly Sensitized Heart and Lung Transplant Recipients

Successful Desensitization by Post-Centrifugal Plasma Filtration in Two Highly Sensitized Heart and Lung Transplant Recipients

Influence of the extracorporeal detoxication methods on the levels of nonessential amino acids in the blood plasma of patients with sepsis (Communicated by Corresponding Member Nikolay S. Serduchenko)

Some disadvantages of the extracorporeal blood purification (EBP) methods as reducing plasma levels of different important metabolites are described. Disorders of amino acid metabolism in sepsis are manifested into microcirculation interruptions, a decreased immune response and an increased mortality. The aim of the study is to investigate the EBP influence on the levels of nonessential amino acids in the blood plasma of patients with sepsis. 28 patients diagnosed with “sepsis” were selected. Standard treatment protocols of plasma filtration, hemofiltration and hemadsorption with various sorbents were used. A significant decrease in the levels of asparagine, phosphoethanolamine, proline; α -aminobutyric acid showed a significant increase in these levels in patients who underwent “Proteasosorb” sorbent hemadsorption. A significant decrease in the levels of ornithine, aspartic acid, 3-methylhistidine, 1-methylhistidine in patients treated with hemofiltration was found. The EBP methods significantly influence the amino acid metabolism.

P1457COMPARISON OF PEPTIDOMES BETWEEN URINE, PLASMA, AND HEMODIALYSIS FLUID INDICATES SELECTIVITY IN RENAL PEPTIDE PROCESSING

Abstract Background and Aims The physiological and related body fluids, urine, plasma and hemodialysis (HD) fluid spent dialysate (a mixture of technical HD fluid and patient´s ultrafiltrate) are rich biological sources of information especially in the context of kidney diseases. Of particular relevance are proteins and peptides, as they reflect essentially every biological process. Urine is produced as a result of glomerular plasma filtration and subsequent tubular reabsorption in the kidney. In analogy, HD spent dialysate is a result of ultrafiltration by an artificial kidney (dialysis membrane), but lacking tubular reabsorption and thereby accumulating in huge amounts of > 100 L per session comparable to primary urine. A recent study suggested that tubular reabsorption may be selective for specific proteins, and this process may represent a major difference between “natural” and artificial kidney. In this study, we aim at gaining insight into the composition of the peptidome/proteome in these body fluids of renal significance in a comprehensive analysis, in order to shed light on the relevant pathophysiological processes that take place in kidney, which may help developing better strategy in advanced-stage chronic kidney disease and detoxification in renal replacement therapies (RRT). Method We collected 15 plasma, 15 urine and 13 HD filtrate (spent dialysate during the first 30min of RRT) from age and sex matched subjects with stage 4 or above chronic kidney disease. Peptide identification and quantification were performed with capillary-electrophoresis coupled mass spectrometry and tandem mass spectrometry (CE-MS). The abundance, overlap and differences of the peptidome/proteome of the three body fluids were evaluated. Results We were able to detect 6281 urinary peptides, 1750 plasma peptides and 1728 peptides from spent dialysate. Of these we could identify 1764, 452 and 374 sequenced peptides, respectively Among them, there are 318 peptides detectable in both urine and spent dialysate, 307 detectable in both plasma and urine and only 191 detectable in both plasma and spent dialysate. Among the most abundant peptides in plasma were Thymosine-ß4 and fragments from hemoglobin, fibrinogen and collagen. In dialysate, the most abundant proteins detected in these patients were ß-2-microglobuline, Thymosine-ß4, and fragments from fibrinogen, while in urine fragments derived from collagen, albumin, and from alpha-1-antitrypsin were of the highest abundance. When investigating proteins/peptides found in at least 2 body fluids, a strong correlation in peptide abundance between urine and spent dialysate (P=4.2e-27, Rho=0.56), and a moderately strong correlation between HD fluid and plasma (P=3.7e-5, Rho=0.29) were detected. However, there is no significant correlation between peptide abundance in urine and plasma (P=0.22, Rho=0.07). Collagen peptides are the most abundant peptides in all three body fluids. Conclusion This dataset will serve as a valid basis to define the protein and peptide contents in blood, urine, and spent dialysate. The data show, as expected, substantial similarity between plasma and spent dialysate, but, surprisingly, very little similarity between urine and plasma. This further supports the hypothesis that tubular reabsorption may be selective for specific proteins and peptides, possibly excluding collagen-derived peptides. A more detailed investigation into the process and relevance of tubular reabsorption appears warranted in the light of the data. The fact that the samples investigated in this study are derived from advanced stage CKD patients must be taken into account, significant differences exist in comparison to urine produced by healthy kidney. The identification of molecular differences between urine and dialysate spent may present an opportunity to design future “biologically adapted” removal devices.

TO013ADSORPTION THERAPY AND SEPTIC SHOCK: A RETROSPECTIVE STUDY COMPARING COUPLED PLASMA FILTRATION-ADSORPTION AND CYTOSORB

Abstract Background and Aims Septic shock is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Excessive release of cytokines and other inflammatory mediators is a key mechanism and cytokines adsorption therapies are applied in this context to restore a balanced immune homeostasis. Different adsorption techniques are available but there are no studies comparing these different adsorption approaches. The aim of this retrospective observational study was to compare Coupled Plasma Filtration Adsorption (CPFA) and CytoSorbTM in terms of hemodynamic and clinical response, mortality and renal function recovery. Method A retrospective observational study was designed enrolling all patients admitted to ICU with a diagnosis of septic shock treated with blood adsorption, either CPFA or CytoSorbTM, from January 2015 to December 2017. Primary endpoints of the study were the assessment of changes in NE dosage, MAP values, SOFA score and PCT levels before and after blood adsorption. Secondary endpoints ICU length of stay (LOS), mortality at 30, 60 and 90 days from adsorption initiation; renal outcome at 30 and 90 days from adsorption initiation. Results The study included 28 patients (14 CPFA, 14 CytosorbTM). Adsorption treatment was associated with a significant (p=0.03) improvement in hemodynamics with a Norepinephrine/Mean Arterial Pressure ratio (NE/MAP) of 0.64 (0.14-2.6) pre-treatment vs 0.11 (0.0-0.32) post-treatment regardless of the applied technique. Furthermore, a significant (p<0.001) procalcitonin (PCT) post treatment reduction was demonstrated with a comparable effect in the two groups (p=0.32) (Fig.1). No difference has been found in SOFA score changes (p=0.06) and again without any difference between groups (p=0.17). Overall Survival (OS) rate at 30 days was comparable between groups being 64.3% in CPFA and 78.6% in CytoSorbTM group (p=0.34). Finally, a complete recovery of kidney function at 30 and 90 days has been obtained in respectively 90% and 100% of survived patients without any difference between groups (p=1.00) (Fig.2). Conclusion These data confirmed the effectiveness of adsorption in terms of short-term clinical improvement independently from the applied technique, supporting the role of both these adjunctive therapies in septic shock treatment. CPFA and CytosorbTM have comparable effects in terms of hemodynamic improvement, clinical outcome, mortality and recovery of kidney function from septic shock AKI.

Effects of Low Chloride versus High Chloride Infusion on Glomerular Filtration Rate and Renal Plasma Flow in Healthy Volunteers—A Randomized, Controlled, Crossover Study

Background: Previous studies have shown that chloride liberal fluids may be associated with worse renal outcomes. Deterioration of kidney function during hyperchloremia/chloride overload is believed to be induced by disturbances in renal perfusion, but exact mechanisms of chloride nephrotoxicity are unclear. The purpose of this randomized, crossover study was to investigate the effect of chloride loading on renal plasma flow (RPF), filtration fraction (FF) and glomerular filtration rate (GFR) in order to elucidate potential nephrotoxic mechanisms of chloride infusion. Methods: Fifteen healthy males were investigated twice after treatment with 2L isotonic saline and plasma-lyte with a wash-out period of at least 10 days. Within 15 mins after completion of infusion, the kidney parameters (RPF, FF and GFR) were estimated by Technetium-99m diethylenetriamine penta-acetic acid (99-mTc-DTPA) renography. Results: 99-mTc-DTPA renography showed reduction in both mean GFR (114 ± 13 ml/min vs.119 ± 12 ml/min, p = 0.04) and RPF (977 ± 272 ml/min vs. 1066 ± 197 ml/min, p = 0.19) and increasing FF (12% ± 2% vs. 11% ± 2%, p = 0.19) after 0.9% saline comparing to Plasmalyte, but only GFR reduction was statistically significant. Reduction in GFR and RPF and increasing in FF after 0.9% saline was observed in 10 subjects while in 5 others the reverse trend was shown. There were no statistically significant differences between mean systolic and diastolic blood pressure (BP) before and after each infusion except baseline diastolic BP. Weight changes (Δ weight) were similar after each infusion. Conclusions: We have demonstrated that high chloride infusion can affect kidney function in healthy subjects and seems to lead to impairment in both RPF and GFR.

Features of chromatographic separation on heteropaternal sorbents

The possibility of using a short 20x4 mm chromatographic column with a heterosurface sorbent for direct determination of theophylline and caffeine in blood plasma and a 120x4 mm column for determination of tetracycline antibiotics in cow’s milk was studied. Complete separation of tetracycline peaks was not achieved. Determination of caffeine and theophylline was performed successfully in plasma filtrates without long and time-consuming stages of preliminary preparation of the sample without protein deposition. Before backwashing, unfiltered blood plasma can be injected in an amount equivalent to 50 mg of dry matter. Retention characteristics of caffeine and theophylline are practically stable: the retention factor of theophylline for k = 4,0 + 0,1 for caffeine k = 8,5 + 0,4 eluent in composition of 0.02 M sodium hydrogen phosphate (pH = 6,0) – acetonitrile (90:10).

The premature closure of ROMPA clinical trial: mortality reduction in septic shock by plasma adsorption

ObjectivesCoupled Plasma Filtration and Adsorption (CPFA) use in septic shock remains controversial. The objective is to clarify whether the application of high doses of CPFA in addition to the current...

Influence of non-Newtonian blood flow models on drug deposition in the arterial wall

In this paper, we investigate the influence of non-Newtonian blood flow models on drug diffusion from a coronary drug-eluting-stent (DES). We consider the Oldroyd-B, Phan-Thien-Tanner (PTT) and Giesekus viscoelastic models for the description of fluid dynamics of blood. The model for blood flow is coupled with plasma filtration and mass transport from a DES. The model for the transport problem takes into consideration non-Fickian diffusion, drug dissolution, polymer degradation and binding. We propose an Implicit-Explicit (IMEX) finite element method and show numerical experiments that confirm the effectiveness and order of convergence of the employed methodology. The numerical results indicate that an increase in the elastic properties of the blood leads to an increase of the concentration of free drug in the arterial wall. Finally, we present unsteady simulations comparing the Newtonian and non-Newtonian blood flow models.

Analytical review of 10-year work of intensive care unit of Moscow’s Municipal Clinical Hospital No. 52

The intensive care unit for nephrological patients is the first such intensive care unit in the Russian Federation and is unique in its specificity. The main task of the ICU department No. 2 is to provide an intensive care complex aimed at restoring and maintaining the vital functions of organs and systems in patients with kidney diseases of various origins, as well as in patients after kidney allotransplantation. The department is equipped with the most advanced equipment for the treatment of multi-organ pathology, including therapeutic plasma exchange, therapeutic plasmapheresis and double cascade plasma filtration.

Fulminant hepatitis and elevated levels of sIL-2R in thyroid storm.

SummaryWe report the case of a 48-year-old man with thyroid storm associated with fulminant hepatitis and elevated levels of soluble interleukin-2 receptor (sIL-2R). Fatigue, low-grade fever, shortness of breath, and weight loss developed over several months. The patient was admitted to the hospital because of tachycardia-induced heart failure and liver dysfunction. Graves’ disease with heart failure was diagnosed. He was treated with methimazole, inorganic iodide, and a β-blocker. On the day after admission, he became unconscious with a high fever and was transferred to the intensive care unit. Cardiogenic shock with atrial flutter was treated with intra-aortic balloon pumping and cardioversion. Hyperthyroidism decreased over 10 days, but hepatic failure developed. He was diagnosed with thyroid storm accompanied by fulminant hepatitis. Laboratory investigations revealed elevated levels of sIL-2R (9770 U/mL). The fulminant hepatitis was refractory to plasma exchange and plasma filtration with dialysis, and no donors for liver transplantation were available. He died of hemoperitoneum and gastrointestinal hemorrhage due to fulminant hepatitis 62 days after admission. Elevated circulating levels of sIL-2R might be a marker of poor prognosis in thyroid storm with fulminant hepatitis.Learning points: The prognosis of thyroid storm when fulminant hepatitis occurs is poor.Liver transplantation is the preferred treatment for fulminant hepatitis induced by thyroid storm refractory to plasma exchange.Elevated levels of soluble interleukin-2 receptor might be a marker of poor prognosis in patients with thyroid storm.

Evaluation of health and quality of life in apheresis patients – data from the WAA register

Objective: The World Apheresis Association (WAA) register contains data from more than 89 000 apheresis procedures in more than 12,000 patients. The aim of this study was to evaluate functional health and quality of life (QoL) in patients during apheresis treatment. Material and methods: Estimates of health condition (HC) were made in 40,445 and of QoL in 22112 apheresis procedures. This study focused on a 10-step graded evaluation of HC (scale from: ‘bedridden, unable to eat’ to a level of ‘athletic competition’) and self-assessment of QoL (scale from: worst ever ‘0’ to best ever ‘10’). Data were compared in relation to various apheresis procedures and if the patient underwent the first or subsequent apheresis procedure. Results: Of the patients treated with plasma exchange (PEX) with centrifugation technique (n = 15787) 10% were ‘bedridden, unable to come out of bed’ while for patients treated with plasma filtration technique (n = 1018) the percentage was 27%. During the first procedure these figures were 16% and 30%, respectively. Self-estimates of QoL were graded ‘zero’ or ‘1’ in 1.6% of patients during the first apheresis procedure; At the first contact patients undergoing PEX graded like this in 4.3%. Conclusion: Many of the patients undergoing apheresis treatment have poor HC and QoL at the start of therapy. Of all therapeutic apheresis procedures patients undergoing PEX had the lowest score of QoL.

LPS-Binding Protein Modulates Acute Renal Fibrosis by Inducing Pericyte-to-Myofibroblast Trans-Differentiation through TLR-4 Signaling.

During sepsis, the increased synthesis of circulating lipopolysaccharide (LPS)-binding protein (LBP) activates LPS/TLR4 signaling in renal resident cells, leading to acute kidney injury (AKI). Pericytes are the major source of myofibroblasts during chronic kidney disease (CKD), but their involvement in AKI is poorly understood. Here, we investigate the occurrence of pericyte-to-myofibroblast trans-differentiation (PMT) in sepsis-induced AKI. In a swine model of sepsis-induced AKI, PMT was detected within 9 h from LPS injection, as evaluated by the reduction of physiologic PDGFRβ expression and the dysfunctional α-SMA increase in peritubular pericytes. The therapeutic intervention by citrate-based coupled plasma filtration adsorption (CPFA) significantly reduced LBP, TGF-β, and endothelin-1 (ET-1) serum levels, and furthermore preserved PDGFRβ and decreased α-SMA expression in renal biopsies. In vitro, both LPS and septic sera led to PMT with a significant increase in Collagen I synthesis and α-SMA reorganization in contractile fibers by both SMAD2/3-dependent and -independent TGF-β signaling. Interestingly, the removal of LBP from septic plasma inhibited PMT. Finally, LPS-stimulated pericytes secreted LBP and TGF-β and underwent PMT also upon TGF-β receptor-blocking, indicating the crucial pro-fibrotic role of TLR4 signaling. Our data demonstrate that the selective removal of LBP may represent a therapeutic option to prevent PMT and the development of acute renal fibrosis in sepsis-induced AKI.

In Vivo Developmental Trajectories of Human Podocyte Inform In Vitro Differentiation of Pluripotent Stem Cell-Derived Podocytes

The renal corpuscle of the kidney comprises a glomerular vasculature embraced by podocytes and supported by mesangial myofibroblasts, which ensure plasma filtration at the podocyte-generated slit diaphragm. With a spectrum of podocyte-expressed gene mutations causing chronic disease, an enhanced understanding of podocyte development and function to create relevant invitro podocyte models is a clinical imperative. To characterize podocyte development, scRNA-seq was performed on human fetal kidneys, identifying distinct transcriptional signatures accompanying the differentiation of functional podocytes from progenitors. Interestingly, organoid-generated podocytes exhibited highly similar, progressive transcriptional profiles despite an absence of the vasculature, although abnormal gene expression was pinpointed in late podocytes. On transplantation into mice, organoid-derived podocytes recruited the host vasculature and partially corrected transcriptional profiles. Thus, human podocyte development is mostly intrinsically regulated and vascular interactions refine maturation. These studies support the application of organoid-derived podocytes to model disease and to restore or replace normal kidney functions.

Continuous plasma filtration adsorption for treatment of acute pancreatitis in pregnancy: analysis of 18 cases

Continuous plasma filtration adsorption for treatment of acute pancreatitis in pregnancy: analysis of 18 cases

Efficacy of Coupled Plasma Filtration Adsorption in Treating Patients with Severe Intra-Abdominal Infection: A Retrospective Study.

Background: Coupled plasma filtration adsorption (CPFA) is an extracorporeal treatment based on plasma filtration associated with an adsorbent cartridge and hemofiltration. CPFA is able to remove inflammatory mediators and it has been used to treat severe sepsis and multiple organ dysfunction. Limited experience exists on the use of CPFA in treating intra-abdominal infection (IAI). Methods: In this study, the efficacy of CPFA in treating patients with severe IAI and liver failure was evaluated in a retrospective analysis of 76 cases. Results: The survival rate of patients treated with CPFA was 82.6%, with effective removal of endotoxin and inflammatory mediators. Conclusion: Our data suggest that CPFA can be safely and effectively used to lower morbidity and mortality rates of patients with severe IAI and liver failure.

Correlation between atherogenic index of plasma and renal function change in the elderly patients with hypertension

Objective To observe the abnormality of lipid metabolism and renal function change in elderly patients with hypertension, and to evaluate the relationship between atherogenic index of plasma(AIP) and glomerular filtration rate(GFR). Methods From July 2015 to June 2017, in Quzhou People′s Hospital, 182 elderly patients with hypertension were selected as observation group, and 192 elderly healthy people with normal blood pressure were selected as control group.The total cholesterol(TC), triglyeride(TG), high density lipoprotein cholesterol(HDL-C) were detected, and the AIP=1og[TG/HDL-C]was calculated.The GFR was estimated by Cockcroft-Gault equation.The relationship between the estimated GFR (eGFR) and the blood lipid parameters was analyzed. Results The eGFR of the observation group and control group were (84.94±19.49)mL·min-1·(1.73m2)-1, (154.91±20.44)mL·min-1·(1.73m2)-1, respectively, the difference between the two groups was statistically significant (t=11.27, P<0.01). The AIP of the observation group and control group were (0.68±0.03), (-0.22±0.02), respectively, the difference between the two groups was statistically significant (t=3.43, P<0.01). There was a negative correlation between AIP and eGFR in the elderly patients with hypertension(r=-0.845, P<0.01). Conclusion The fact shows that abnormality of lipid metabolism in the elderly patients with hypertension is present.AIP can be used as a plasma marker of atherosclerosis and could be used as a useful and important parameter for clinical observation in the elderly hypertensive patients with renal impairment. Key words: Hypertension; Atherogenic index of plasma(AIP); Dyslipidemias; Glomerular filtration rate

LPS removal reduces CD80-mediated albuminuria in critically ill patients with Gram-negative sepsis.

LPS-induced sepsis is a leading cause of acute kidney injury (AKI) in critically ill patients. LPS may induce CD80 expression in podocytes with subsequent onset of proteinuria, a risk factor for progressive chronic kidney disease (CKD) frequently observed after AKI. This study aimed to investigate the therapeutic efficacy of LPS removal in decreasing albuminuria through the reduction of podocyte CD80 expression. Between January 2015 and December 2017, 70 consecutive patients with Gram-negative sepsis-induced AKI were randomized to either have coupled plasma filtration and adsorption (CPFA) added to the standard care ( n = 35) or not ( n = 35). To elucidate the possible relationship between LPS-induced renal damage, proteinuria, and CD80 expression in Gram sepsis, a swine model of LPS-induced AKI was set up. Three hours after LPS infusion, animals were treated or not with CPFA for 6 h. Treatment with CPFA significantly reduced serum cytokines, C-reactive protein, procalcitonin, and endotoxin levels in patients with Gram-negative sepsis-induced AKI. CPFA significantly lowered also proteinuria and CD80 urinary excretion. In the swine model of LPS-induced AKI, CD80 glomerular expression, which was undetectable in control pigs, was markedly increased at the podocyte level in LPS-exposed animals. CPFA significantly reduced LPS-induced proteinuria and podocyte CD80 expression in septic pigs. Our data indicate that LPS induces albuminuria via podocyte expression of CD80 and suggest a possible role of timely LPS removal in preventing the maladaptive repair of the podocytes and the consequent increased risk of CKD in sepsis-induced AKI.

Preparation, Procedures and Evaluation of Platelet-Rich Plasma Injection in the Treatment of Knee Osteoarthritis.

Knee osteoarthritis (KOA) is one of the most frequently encountered diseases in the orthopedic department. Existing non-surgical treatments have a limited effect on the repair of cartilage and on bone regeneration. Platelet-rich plasma (PRP) is an autologous bioactive substance that can repair cartilage injury and accelerate bone regeneration effectively. However, reporting of PRP preparation protocols in clinical studies is highly inconsistent, with the majority of studies providing insufficient information to allow the protocol to be reproduced. We describe a repeatable method of preparing PRP visually, the treatment of KOA using PRP intra-articular injection, and methods of evaluating the outcome. PRP was prepared using manual double centrifugation. The PRP layer was extracted from peripheral blood and used for knee joint cavity injection. Evaluations included assessments of blood platelet concentrations and clinical outcomes. Preparation of PRP by manual centrifugation requires less apparatus and is less costly than plasma filtration or centrifugation using equipment. The centrifugation time of our double centrifugation method was 6 and 5 minutes for the respective centrifugations at forces of 800 and 1400 x g, respectively, to allow for the consistent preparation of standardized PRP. However, a manual method is susceptible to operator error, and PRP batch preparation is not available. Intra-articular injection of PRP proved to be an effective treatment for knee osteoarthritis. The entire treatment procedure took less than 30 minutes, the blood platelet concentration of PRP could be standardized, and treatment was proven to be effective when evaluated by follow-up.

Experience with the use of selective plasma exchange in patients with newly detected secreting multiple myeloma

The prospects of using the selective plasma exchange in the treatment of first identified multiple myeloma (secretory) is substantiated (MM). Twenty-four patients (16 men and 8 women) were examined with stage II−III of the disease. Patients were divided into two groups: the main group (n = 13) with inclusion in therapy selective plasma exchange were included in the treatment and a control group (n = 11) — were treated according to standard protocol. The patients received specific treatment according to the VCD scheme. The concentrations of paraprotein, free light chains Ig (FLC), glomerular filtration rate (GFR), blood toxicity and the functional characteristics of albumin were studied. The studies were conducted before and after the completion of chemotherapy. Additionally, the concentration of paraprotein, FLC and MSM (molecules with average mass) in the blood serum were determined before and 30 min after the end of selective plasma exchange, as well as in the plasma filtrate. The results of the study showed that the inclusion of selective plasma exchange in the treatment ensured the excretion of more than 50 % of the paraprotein and FLC in the blood, a decrease in their concentration after the completion of the procedure: paraprotein 32 %, κ — FLC 43 %, λ — FLC 68 %. There was a greater regression of monoclonal protein levels and FLC production with a marked decrease in the indices of endogenous intoxication and an improvement in the functional properties of the albumin in the main group as compared with the control after completing the chemotherapy course. In the group of patients a more best to the therapy was obtained: a good response — in 69.2 % of the patients (in the control group — in 45.5 %); a negative response — in 30.8 % of cases against 54.5 % in the control group. The obtained results suggested that including selective plasma exchange in the specific complex therapy of patients with first identified multiple myeloma allows to reduce the volume of paraprotein, increase the degree and rate of reduction of LC, without affecting the toxicity of the therapy, which contributes to the strengthening of hematological and renal response to ongoing treatment.