Use of Immunoadsorption and Plasma Exchange for Treating Anti–Glomerular Basement Membrane Disease: Clinical Experience in Germany

Anti-glomerular basement membrane (anti-GBM) disease presents with acute glomerulonephritis and pulmonary hemorrhage. 1 McAdoo S.P. Pusey C.D. Anti-Glomerular Basement Membrane Disease. Clin J Am Soc Nephrol. 2017; 12: 1162-1172https://doi.org/10.2215/cjn.01380217 Crossref PubMed Scopus (0) Google Scholar In the absence of plasma exchange (PLEX) therapy and immunosuppression, anti-GBM disease typically takes on a lethal course. 2 Beck Jr., L.H. Ayoub I. Caster D. et al. KDOQI US Commentary on the 2021 KDIGO Clinical Practice Guideline for the Management of Glomerular Diseases. Am J Kidney Dis. 2023; 82: 121-175https://doi.org/10.1053/j.ajkd.2023.02.003 Abstract Full Text Full Text PDF Scopus (2) Google Scholar Immunoadsorption (IA) offers potential benefits over PLEX, as it selectively eliminates circulating antibodies without removing several important plasma components. 3 Laczika K. Knapp S. Derfler K. Soleiman A. Hörl W.H. Druml W. Immunoadsorption in Goodpasture's syndrome. Am J Kidney Dis. 2000/08/01/ 2000; 36: 392-395https://doi.org/10.1053/ajkd.2000.8993 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ,4 Connelly-Smith L. Alquist C.R. Aqui N.A. et al. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue. J Clin Apher. 2023; 38: 77-278https://doi.org/10.1002/jca.22043 Crossref PubMed Scopus (53) Google Scholar However, in the context of anti-GBM disease it finds little recognition in contemporary literature. 5 Sethi S. De Vriese A.S. Fervenza F.C. Acute glomerulonephritis. Lancet. 2022; 399: 1646-1663https://doi.org/10.1016/s0140-6736(22)00461-5 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar Given this situation, the 2021 KDIGO guidelines for the management of glomerular diseases have called for intensified research efforts. 6 KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int. 2021; 100: S1-s276https://doi.org/10.1016/j.kint.2021.05.021 Abstract Full Text Full Text PDF PubMed Scopus (754) Google Scholar Using previously established methodology, 7 Kolbrink B. Scheikholeslami-Sabzewari J. Borzikowsky C. et al. Evolving epidemiology of pneumocystis pneumonia: Findings from a longitudinal population-based study and a retrospective multi-center study in Germany. Lancet Reg Health Eur. 2022; 18100400https://doi.org/10.1016/j.lanepe.2022.100400 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar we assessed the in-hospital course following treatment with IA compared to PLEX, leveraging the largest cohort ever accumulated on this subject.