Cargando…
Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome
Plasma exchange rapidly depletes pathogenic anti-neutrophil cytoplasmic autoantibodies (ANCAs) and is considered for induction therapy in severe ANCA-associated vasculitis. The aim of plasma exchange is to remove putative disease mediators from the circulation, such as toxic macromolecules and patho...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288105/ https://www.ncbi.nlm.nih.gov/pubmed/37359542 http://dx.doi.org/10.3389/fimmu.2023.1210321 |
_version_ | 1785062008857559040 |
---|---|
author | Schäfer, Ann-Kathrin Dierks, Sascha Schnelle, Moritz Korsten, Peter Hakroush, Samy Tampe, Björn |
author_facet | Schäfer, Ann-Kathrin Dierks, Sascha Schnelle, Moritz Korsten, Peter Hakroush, Samy Tampe, Björn |
author_sort | Schäfer, Ann-Kathrin |
collection | PubMed |
description | Plasma exchange rapidly depletes pathogenic anti-neutrophil cytoplasmic autoantibodies (ANCAs) and is considered for induction therapy in severe ANCA-associated vasculitis. The aim of plasma exchange is to remove putative disease mediators from the circulation, such as toxic macromolecules and pathogenic ANCAs. To our knowledge, we here provide the first report of applying high-dose IVIGs prior to plasma exchange and assessment of ANCA autoantibody elimination in a patient with severe pulmonary renal syndrome due to ANCA-associated vasculitis. After high-dose application of intravenous immunoglobulins (IVIGs) prior to plasma exchange treatment, efficacy of myeloperoxidase (MPO)-ANCA autoantibody elimination was substantially increased, associated with rapid clearance of MPO-ANCA autoantibodies. High-dose IVIGs resulted in marked reduction of MPO-ANCA autoantibody levels and did not directly affect autoantibody clearance by plasma exchange itself, as also confirmed by comparable MPO-ANCAs in the exchange fluid relative to serum levels. Moreover, measurements of serum creatinine and albuminuria confirmed that high-dose IVIGs were well tolerated and did not exacerbate kidney injury. |
format | Online Article Text |
id | pubmed-10288105 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-102881052023-06-24 Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome Schäfer, Ann-Kathrin Dierks, Sascha Schnelle, Moritz Korsten, Peter Hakroush, Samy Tampe, Björn Front Immunol Immunology Plasma exchange rapidly depletes pathogenic anti-neutrophil cytoplasmic autoantibodies (ANCAs) and is considered for induction therapy in severe ANCA-associated vasculitis. The aim of plasma exchange is to remove putative disease mediators from the circulation, such as toxic macromolecules and pathogenic ANCAs. To our knowledge, we here provide the first report of applying high-dose IVIGs prior to plasma exchange and assessment of ANCA autoantibody elimination in a patient with severe pulmonary renal syndrome due to ANCA-associated vasculitis. After high-dose application of intravenous immunoglobulins (IVIGs) prior to plasma exchange treatment, efficacy of myeloperoxidase (MPO)-ANCA autoantibody elimination was substantially increased, associated with rapid clearance of MPO-ANCA autoantibodies. High-dose IVIGs resulted in marked reduction of MPO-ANCA autoantibody levels and did not directly affect autoantibody clearance by plasma exchange itself, as also confirmed by comparable MPO-ANCAs in the exchange fluid relative to serum levels. Moreover, measurements of serum creatinine and albuminuria confirmed that high-dose IVIGs were well tolerated and did not exacerbate kidney injury. Frontiers Media S.A. 2023-06-09 /pmc/articles/PMC10288105/ /pubmed/37359542 http://dx.doi.org/10.3389/fimmu.2023.1210321 Text en Copyright © 2023 Schäfer, Dierks, Schnelle, Korsten, Hakroush and Tampe https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Immunology Schäfer, Ann-Kathrin Dierks, Sascha Schnelle, Moritz Korsten, Peter Hakroush, Samy Tampe, Björn Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title | Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title_full | Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title_fullStr | Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title_full_unstemmed | Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title_short | Case Report: High-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
title_sort | case report: high-dose immunoglobulins prior to plasma exchange in severe pulmonary renal syndrome |
topic | Immunology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10288105/ https://www.ncbi.nlm.nih.gov/pubmed/37359542 http://dx.doi.org/10.3389/fimmu.2023.1210321 |
work_keys_str_mv | AT schaferannkathrin casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome AT dierkssascha casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome AT schnellemoritz casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome AT korstenpeter casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome AT hakroushsamy casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome AT tampebjorn casereporthighdoseimmunoglobulinspriortoplasmaexchangeinseverepulmonaryrenalsyndrome |