ANCA関連腎炎におけるアフェレシス(<特集>腎疾患とアフェレシス-最近の知見-)

概要

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Anti-neutrophil cytoplasmic autoantibody (ANCA)-associated small vessel vasculitides (AAV) encompass Wegener's granulomatosis (WG), microscopic polyangiitis (MPA), renal limited vasculitis and Churg-Strauss syndrome (CSS). Initial immunosuppressive therapy in AAV typically consists of cyclophosphamide and glucocorticoids. Regarding apheresis, early data from randomized controlled trials (RCTs) of plasma exchange (PLEX) in patients with rapidly progressive glomerulonephritis revealed conflicting results. In the MEPEX trial, PLEX increased the rate of renal recovery among patients with AAV who presented with renal failure when compared with intravenous methylprednisolone. This trial enrolled 137 patients whose mean serum creatinine at presentation was 8.3mg/dL and 69% required dialysis. Presently, an international RCT of PEXIVAS is ongoing. This trial will clarify the effect of PLEX on end-stage renal disease and mortality among 500 AAV patients with eGFR below 50mL/min and/or pulmonary hemorrhage. Mechanisms of PLEX in AAV include removal of pathological circulating factors and excess physiological factors. Cytapheresis is another option that removes pathogenic leukocytes. In this article, apheresis in the treatment of ANCA-associated glomerulonephritis is reviewed.
2011-05-31