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

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Introduzione

Nel 1998, in occasione del congresso ERA-EDTA tenutosi a Rimini, Stewart Cameron, uno dei padri storici della moderna nefrologia, sintetizzò in una diapositiva la clinical competence dei nefrologi (Figura 1). Cameron sottolineava allora che tra le molteplici attitudini e capacità che deve avere un nefrologo vi è una peculiarità, cioè la capacità di gestire tutte le tecniche di depurazione extracorporea e, tra queste, anche l’aferesi terapeutica. 

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