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Chinese Journal of Blood Purification ›› 2005, Vol. 4 ›› Issue (9) : 472-475.

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Abstract

Objectives To investigate the efficacy of Protein A immunoadsorption (IA) in the treatment of rapidly progressive glomerulonephritis and its influence the serum level of antineutrophil cytoplasmic antibody (ANCA) and anti-GBM antibody. Methods Five cases of rapidly progressive glomerulonephritis were involved whose renal biopsy showed that crescents was present in more than 50% of the glomeruli (56.7～5.9％). Of those cases, 3 accompanied with type 2 diabetes mellitus and 3 accompanied with interstitial pneumonia. All of the 5 patients had undertaken IA as well as the drug therapy with glucocorticoids and cyclophosphamides. Results Serum level of ANCA-MPO was reduced significantly after a single IA（54.34±31.73 vs 87.96±46.67, P=0.003）.There was also a reduction of serum anti-GBM antibody, but there was no statistic significance（13.00±11.61 vs 23.53±24.27,P=0.079）.Renal function were improved significantly in two cases who need dialysis therapy before IA. One of them didn't need dialysis support after IA therapy whose serum creatinine reduced from 710μmol/L to 350μmol/L. The other three cases also resulted in obvious amelioration of renal impairment after IA therapy, serum creatinine dropped from 586μmol/L、197μmol/L、367μmol/L to 261μmol/L、136μmol/L、236μmol/L respectively after several sessions of IA. Pulmonary interstitial lesions were improved in all cases. There were no changes in liver function, serum electrolytes, serum glucose, oxygen saturation or blood routine after IA therapy. Patients' vital signs such as blood pressure, heart rate and respiratory rate also kept steady during each session. All of the 5 patients survived. Conclusions Staphylococcus protein A immunoadsorption therapy combined with impulse therapy of glucocorticoids and cyclophosphamides significantly lowered the auto-antibodies like ANCA and anti-GBM antibody in the circulation of the patients with rapidl progressive glomerulonephritis. This combined therapy can resulted in improvement in renal function and rapid remission of the disease.