long-term therapeutic plasma exchange to prevent end-stage kidney disease in adult severe resistant henoch-schonlein purpura nephritis
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ID: 152574
2015
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Abstract
A 27-year-old man presented with a palpable purpuric skin rash and joint and abdominal pain in April 2010. He had acute kidney injury and his creatinine quickly deteriorated to 687 μmol/L, with associated nephrotic range proteinuria. Kidney biopsy showed crescentic Henoch-Schonlein nephritis. He was treated with intravenous cyclophosphamide and prednisolone despite which his renal function deteriorated; he required haemodialysis for a short duration and seven sessions of therapeutic plasma exchange (TPE). Renal function improved, but after discharge from hospital he suffered 2 further relapses, each with AKI, in 4 months. Cyclophosphamide was not effective and therefore Rituximab was introduced. He initially had a partial response but his renal function deteriorated despite continued therapy. TPE was the only treatment that prevented rapid renal functional deterioration. A novel long-term treatment strategy involving regular TPE every one to two weeks was initiated. This helped to slow his progression to end-stage kidney disease over a 3-year period and to prolong the need for renal replacement therapy over this time.
| Reference Key |
hamilton2015caselong-term
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|---|---|
| Authors | ;Patrick Hamilton;Olumide Ogundare;Ammar Raza;Arvind Ponnusamy;Julie Gorton;Hana Alachkar;Jamil Choudhury;Jonathan Barratt;Philip A. Kalra |
| Journal | molecular nutrition and food research |
| Year | 2015 |
| DOI |
10.1155/2015/269895
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| URL | |
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