Abstract: SA-PO666
The Short-Time Efficacy and Safety of Immunoadsorption onto Protein A, Compared with Plasma Exchange, in the Treatment of Severe Immunological Nephropathy
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Chu, Xiaoxin, Tongji Hospital, Huazhong Univ of Science and Technology, Wuhan, Hubei, China
- Xu, Gang, Tongji Hospital, Huazhong Univ of Science and Technology, Wuhan, Hubei, China
- Zeng, Rui, Tongji Hospital, Huazhong Univ of Science and Technology, Wuhan, Hubei, China
Background
The efficacy and safety of immunoadsorption onto protein A (IA), compared to plasma exchange (PE), in the treatment of severe anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and lupus nephritis (LN), are few reported.
Methods
The clinical data of 42 patients with severe immunological nephropathy, including 21 treated with IA from Nov 1, 2016 to Nov 31, 2018 and 21 treated with plasma exchange (PE) from Nov 1, 2014 to Nov 31, 2018 in our hospital were retrospectively analyzed. IA or PE was combined glucocorticoid, with or without immunosuppressant regimen as induction immunosuppression. IA was performed 10 cycles every time and was done 3-7 times. PE was performed 3-6 times with plasma and albumin. All the patients were followed up prospectively for 3 months.
Results
In AAV patients, Hb, PLT, Glb, SCr, IgA, IgG, IgM, C3, C4, Fg and BVAS were significantly decreased after IA treatment, P<0.05. The decline of ANCA and IgG were 46.11% and 53.76% after the first time IA treatment. After the 3-7 times IA treatment, ANCA and IgG decreased by 82.48%, 77.81%, respectively. In LN patients, Glb, SCr, IgA, IgG, IgM, Fg and SLEDAI-2k were significantly lower after IA treatment, P<0.05, while eGFR was increased, P<0.05. After IA treatment, the reduction rates of anti-dsDNA Ab and IgG were 72.14%, 44.31%, respectively.
There was no significant change in PT and INR in IA group, but in PE group PT and INR were longer than that before treatment, P<0.05. The Fg decline in IA and PE group were 46.74±25.32%, 66.01±13.98%, respectively, P<0.05. There were 4 patients in the PE group who were transfused with cryoprecipitate due to poor coagulation function but no one in IA group, P<0.05. The main adverse event of IA treatment is hypotension during processes, but for PE treatment is allergies, manifested as rashes. There was no difference in the incidence of adverse events, P>0.05. After 3 month follow-up, albumin in IA group was higher than that in PE group, P<0.05.
Conclusion
IA combined with glucocorticoid, with or without immunosuppressant, resulted in similar rapid removement of pathogenic autoantibodies and similar rapid improvement of renal function as PE did in the short term, but IA treatment induced less coagulation disorders, which potentially decreased the risk for bleeding, compared to PE treatment.
Funding
- Government Support - Non-U.S.