Plasma-exchange and glomerulonephritis

Plasma exchange, combined with immunosuppressive drugs, is indicated either for treatment of anti-GBM-Ab-nephritis, particularly the Goodpasture syndrome, or of some forms of rapidly progressive immune complex nephritis. By its rapid and efficient elimination of pathogenic antibodies, immune complexes, inflammatory mediators, coagulation factors and toxic agents, the course of the glomerular disease may be favourably influenced. Since controlled studies are actually lacking, the indications for therapeutic plasma exhange, however, should be done with restriction. The treatment has to be confined to patients with rapidly progressive glomerulonephritis who do not react to conservative regimens, i.e. immunosuppressive drugs and/or steroids. In addition, this therapy has to be performed in the hospital, is costly and requires a good vascular access.