Is apheresis still a useful tool in the treatment of nephrological diseases?

Abstract

Therapeutic apheresis is by now a century-old extracorporeal procedure, but it is still very much relevant thanks to advances in medical device technology. In addition to the classic plasma exchange, we now have double filtration techniques, plasma absorption, immunoadsorption, leuko and cyto-apheresis, LDL apheresis. The application of these highly selective techniques has opened up new perspectives in the treatment of various nephrological diseases. Unfortunately, renal diseases that can be treated with apheretic techniques are often relatively rare and this prevents us from carrying out extensive studies aimed at demonstrating the real benefits of these methods. Every three years, the American Society of Apheresis provides solid recommendations regarding the diseases that can be treated with apheresis. New immunosuppressants, immuno-modulating substances and monoclonal antibodies are becoming extremely selective and sophisticated weapons against diseases with a clearly identified causal agent. This does not exclude the fact that, due to economic reasons or even to minimize the side effects of these new drugs, apheretic techniques could still retain an important, if ancillary, role. 

Keywords: plasmapheresis, plasma exchange, immunoadsorption, LDL apheresis, cascade plasmapheresis, double filtration, cytoapheresis

Sorry, this entry is only available in Italian.

Apheresis Techniques

Abstract

Apheresis therapies play an important role in the treatment of many pathologies, both as first-line and rescue therapies after drug failure or drug toxicity and, furthermore, when it is important to reach a therapeutic goal in a short time.

Apheresis devices have evolved at an astounding rate over the last decades.

Therapeutic apheresis are usually part of a treatment plan, so, a patient-centered approach to select the most appropriate treatment for each patient, balancing personal preferences, medication interferences and technological availability can significantly influence the choice of the protocol to be used. But, if the wide diversity of apheresis treatments may offer a tailored-patient approach, it can also create concerns on the right decision about the most appropriate protocol.

Therapeutic apheresis – whose purpose is to cure diseases due to abnormality of blood cells or to toxicity of plasma substances – and, productive apheresis – whose purpose is to produce autologous or allogeneic therapeutic hemocomponents – are widely known as plasma-treatments and cytapheresis.

The elementary techniques in apheresis are well represented by three physical separation methods of blood components:

  1. differential centrifugation
  2. membrane filtration
  3. adsorption of proteins or cells, from whole blood or from plasma already separated.

Starting from these three processes, several apheretic techniques have been developed to ensure, in expert hands, excellent therapeutic efficacy together with a low profile of adverse events.

KEY WORDS: Apheresis, techniques, plasma-treatment, cytapheresis, blood-cell separators.

Sorry, this entry is only available in Italian.