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Plasmapheresis in Pediatric Renal Disease

  • Daniella Levy-Erez
  • Haewon C. KimEmail author
Chapter

Abstract

Plasmapheresis or therapeutic plasma exchange has been known to be useful either as a first-line treatment or a second-line therapy in pediatric renal disease. Data is limited in children, and the vast majority of the data is extrapolated from adult-based evidence. Of the many kidney diseases in children, TPE may be beneficial in a small number of diseases. These include glomerular disease with a rapidly progressive form, such as ANCA-associated rapidly progressive glomerulonephritis; anti-glomerular basement membrane (anti-GBM) disease (Goodpasture’s syndrome); nephrotic syndrome such as focal segmental glomerulosclerosis (FSGS), specifically after recurrence in kidney transplant; thrombotic microangiopathy (primary or secondary; and ABO incompatible kidney transplant or antibody-mediated rejection. This chapter reviews therapeutic apheresis with emphasis on special technical considerations unique to pediatric patients, including securing adequate vascular access, maintaining desired intravascular volume and circulating red cell mass, and preventing complications by early recognition of adverse reactions. Clinical applications of plasmapheresis in pediatric patients with renal diseases are discussed on the basis of evidence utilizing the American Society for Apheresis (ASFA) guidelines. Furthermore, the most current data on plasmapheresis in renal diseases, the indications and plasmapheresis treatment approach, as well as specific technical considerations in children are presented.

Keywords

Plasma exchange Plasmapheresis Therapeutic plasma exchange Photopheresis Extracorporeal photopheresis Rapidly progressive glomerulonephritis Thrombotic microangiopathy ANCA-associated glomerulonephritis Anti-GBM glomerulonephritis Focal segmental glomerulosclerosis (FSGS) Antibody-mediated renal allograft rejection Sepsis Multiorgan failure 

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of NephrologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of PediatricsThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  4. 4.Department of Pathology and Laboratory MedicineThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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