Abstract: SA-PO254

Pulmonary and Renal Outcomes in Patients with Pulmonary Renal Syndromes Treated with Plasmapheresis at VCU

Session Information

Category: Glomerular

  • 1005 Clinical Glomerular Disorders

Authors

  • Vagts, Christen, VCUHS, Richmond, Virginia, United States
  • Grossman, Catherine, VCUHS, Richmond, Virginia, United States
  • Kidd, Jason M., VCUHS, Richmond, Virginia, United States
Background

Pulmonary renal syndromes (PRS) are a group of vasculitis syndromes characterized by pulmonary capillaritis, often resulting in diffuse alveolar hemorrhage, and glomerulonephritis. This includes anti-GBM disease and ANCA-associated vasculitis. The indications for plasmapheresis vary based upon the type of pulmonary renal syndrome and their presenting kidney function. The purpose of this study was to characterize patients with PRS treated with plasmapheresis at VCU, identify outcomes of pulmonary and renal functions of these patients, and to correlate estimated 30 day mortality with use of APACHE-II scoring with actual 30 day mortality.

Methods

A retrospective review of patients with PRS treated with plasmapheresis between 2006 and 2014 at VCU was conducted from a pre-existing database. Data regarding presentation, clinical course, follow up, and mortality were collected and evaluated.

Results

A total of 17 patients treated with plasmapheresis for a PRS were identified; eight had anti-GBM disease and nine had ANCA-associated vasculitis (AAV). 66% of patients with AAV were African American and 37.5% of patients with anti-GBM disease were African American. More patients with anti-GBM disease were tobacco users. Patients with AAV had a higher incidence of diffuse alveolar hemorrhage (78% vs. 25% patients with anti-GBM disease) and higher rates of intubation (78% vs. 11% patients with anti-GBM disease). More patients with anti-GBM disease presented with high degree renal failure, defined as Cr >5.7 (50% vs. 22% of patients with AAV). All patients with anti-GBM disease required hemodialysis (HD) during the plasmapheresis treatment period and all required chronic dialysis. In-hospital mortality was higher in patients with AAV (55% vs. 0% of patients with anti-GBM disease). APACHE-II scores appeared similar between the two groups, while both 30 day and 1 year mortality was higher in AAV (44% 30-day and 55% 1-yr mortality vs. 0% and 12.5% in anti-GBM disease respectively).

Conclusion

Patients with PRS requiring treatment with plasmapheresis had varying outcomes, with anti-GBM disease having overall worse renal-related morbidity but improved mortality when compared to ANCA associated disease.