PMID- 28110970 OWN - NLM STAT- MEDLINE DCOM- 20180209 LR - 20180209 IS - 1872-9177 (Electronic) IS - 1769-7255 (Linking) VI - 13 IP - 1 DP - 2017 Feb TI - [Plasma exchange in nephrology: Indications and technique]. PG - 43-55 LID - S1769-7255(16)30645-9 [pii] LID - 10.1016/j.nephro.2016.12.002 [doi] AB - Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Compensation by viro-attenuated plasma is reserved solely for the treatment of thrombotic microangiopathies or when there is a risk of bleeding, because this product is very allergenic and expensive. The treatment goal for a plasma exchange session should be between one and one and one-half times the patient's plasma volume estimated at 40 mL/kg body weight. The anticoagulation is best ensured by the citrate. Complications of plasma exchange are quite rare according to the French hemapheresis registry. The level of evidence of efficacy of plasma exchange in nephrology varies from one pathology to another. Main indications of plasma exchange in nephrology are Goodpasture syndrome, antineutrophil cytoplasmic antibody vasculitis when plasma creatinine is greater than 500 mumol/L, and thrombotic microangiopathies. During renal transplantation, plasma exchange may be proposed in the context of human leukocyte antigen (HLA) desensitization protocols or ABO-incompatible graft. After renal transplantation, plasma exchange is indicated as part of the treatment of acute humoral rejection or recurrent focal segmental glomerulosclerosis on the graft. Plasma exchanges are also proposed in the management of cryoglobulinemia or polyarteritis nodosa. Hemodialysis with membranes of very high permeability tends to replace plasma exchange for myeloma nephropathy. The benefit from plasma exchange has not been formally demonstrated for the treatment of severe lupus or antiphospholipid antibody syndrome. There is no indication of plasma exchange in the treatment of scleroderma or nephrogenic systemic fibrosis. More selective apheresis techniques such as immunoadsorption are currently proposed to replace plasma exchange. CI - Copyright (c) 2016. Published by Elsevier SAS. FAU - Ridel, Christophe AU - Ridel C AD - Service des urgences nephrologiques et transplantation renale, hopital Tenon, 4, rue de la Chine, 75020 Paris, France; Universite Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. Electronic address: christophe.ridel@aphp.fr. FAU - Kissling, Sebastien AU - Kissling S AD - Service des urgences nephrologiques et transplantation renale, hopital Tenon, 4, rue de la Chine, 75020 Paris, France; Universite Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Service de nephrologie et hypertension, centre hospitalier universitaire vaudois (CHUV), 21, rue du Bugnon, 1011 Lausanne, Suisse. FAU - Mesnard, Laurent AU - Mesnard L AD - Service des urgences nephrologiques et transplantation renale, hopital Tenon, 4, rue de la Chine, 75020 Paris, France; Universite Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. FAU - Hertig, Alexandre AU - Hertig A AD - Service des urgences nephrologiques et transplantation renale, hopital Tenon, 4, rue de la Chine, 75020 Paris, France; Universite Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. FAU - Rondeau, Eric AU - Rondeau E AD - Service des urgences nephrologiques et transplantation renale, hopital Tenon, 4, rue de la Chine, 75020 Paris, France; Universite Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France. LA - fre PT - Journal Article TT - Echanges plasmatiques en nephrologie : techniques et indications. DEP - 20170116 PL - France TA - Nephrol Ther JT - Nephrologie & therapeutique JID - 101248950 RN - 0 (Anticoagulants) RN - 0 (Colloids) SB - IM MH - Anticoagulants/therapeutic use MH - Colloids MH - Humans MH - Kidney Diseases/*therapy MH - *Plasma Exchange/methods OTO - NOTNLM OT - Apheresis OT - Apherese OT - Immunoadsorption OT - Immunoadsorption therapy OT - Plasma OT - Plasma exchange OT - Solute de substitution OT - Substitution solute OT - Echange plasmatique EDAT- 2017/01/24 06:00 MHDA- 2018/02/10 06:00 CRDT- 2017/01/24 06:00 PHST- 2017/01/24 06:00 [pubmed] PHST- 2018/02/10 06:00 [medline] PHST- 2017/01/24 06:00 [entrez] AID - S1769-7255(16)30645-9 [pii] AID - 10.1016/j.nephro.2016.12.002 [doi] PST - ppublish SO - Nephrol Ther. 2017 Feb;13(1):43-55. doi: 10.1016/j.nephro.2016.12.002. Epub 2017 Jan 16.