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Immunological Monitoring of Plasma Exchange in Primary IgA Nephropathy
Author(s) -
Coppo Rosanna,
Basolo Bruno,
Roccatello Dario,
Giachino Osvaldo,
Lajolo Donatella,
Martina Guido,
Rollino Cristiana,
Amore Alessandro,
Costa Maria,
Piccoli Giuseppe
Publication year - 1985
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1985.tb04400.x
Subject(s) - medicine , mononuclear phagocyte system , immunology , nephritic syndrome , nephropathy , immune system , antibody , renal function , complement system , glomerulonephritis , gastroenterology , kidney , endocrinology , diabetes mellitus
Plasma exchange (PE) has recently been proposed for primary immunoglobulin (Ig)‐A nephropathy (PIgAGN) with progressive course. To develop suitable guidelines for PE in these cases, the authors evaluated the clinical usefulness of some immunological parameters in five patients with PIgAGN treated with PE combined with immunosuppressive drugs and small doses of corticosteroids. These parameters included the levels of IgA‐containing immune complexes (IgAIC) by a specific conglutinin assay, the function of the mononuclear phagocyte system (MPS) by the in vivo clearance of IgG‐sensitized erythrocytes, and complement activation as determined by C3d measurement. HLA types were also determined. Three patients had an acute nephritic syndrome with a rapidly progressive course, one of them showing sclerotic histologic changes. The two other cases had a relentless progression toward renal failure. In the patient with sclerotic PIgAGN, the MPS function was normal and the IgAIC and C3d levels were low throughout the treatment. In the other four cases, the high IgAIC and C3d levels and the MPS dysfunction found before treatment markedly improved after several PEs. The immunological parameters remained normal during the post‐PE follow‐up in two cases with acute nephritic syndrome and rapidly progressive course, but worsened again in two cases with a relentless course, particularly in one who possessed the B8/DR3 HLA type. Immunological monitoring including IgAIC, C3d, and MPS function is proposed, in addition to histological and clinical evaluation, as a guideline for PE in PIgAGN with evolving course.