Plasmapheresis Is Associated With Better Renal Outcomes in Lupus Nephritis Patients With Thrombotic Microangiopathy: A Case Series Study. Issue 18 (May 2016)

• Record Type: Journal Article
• Authors: Li, Qiu-Yu; Yu, Feng; Zhou, Fu-De; Zhao, Ming-Hui
• Editors: Patel., Sanket
• Is Part Of: Medicine. Volume 96:Issue 18(2017)
• Page Start: e3595
• Publication Date: 2016-05
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000003595
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract : Supplemental Digital Content is available in the text Abstract : Abstract: The aim of this study was to evaluate the efficacy of plasmapheresis in patients with lupus nephritis-combined thrombotic microangiopathy (TMA) in a Chinese cohort. Clinical and therapeutic data of patients with lupus nephritis–combined TMA were collected retrospectively. A comparison between those with and without plasmapheresis was performed. Seventy patients with renal biopsy-proven TMA in lupus nephritis were treated with conventional combined corticosteroid and immunosuppressive agents as induction therapy, 9 of the 70 patients received additional plasmapheresis. The plasmapheresis group presented with more severe SLE and renal activity indices, including a significant higher ratio of neurologic disorder ( P = 0.025), lower level of platelet count ( P = 0.009), higher value of serum creatinine ( P = 0.038), higher percentage of anti-cardiolipin antibodies positive ( P = 0.001), and higher Systemic Lupus Erythematosus Disease Activity Index scores ( P = 0.012), than that of the nonplasmapheresis group. However, the plasmapheresis group had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group ( P = 0.03). As the baseline data were significantly different between the 2 groups, the propensity score match was further designed to avoid retrospective bias. After re-analysis, the plasmapheresis group still had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group ( P = 0.018). More importantly, the plasmapheresis group had significant less composite endpoints than that of the nonplasmapheresis group ( P = 0.005). Our study suggested that additional plasmapheresis on conventional induction therapy may benefit patients with lupus nephritis-combined TMA, which warrants further explorations.