Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • News & Views
  • Published:

Glomerular disease

ANCA-associated GN—to PLEX or not to PLEX?

Plasma exchange (PLEX) is often included in the initial therapy of patients with antineutrophil cytoplasmic autoantibody-associated glomerulonephritis who present with severe kidney failure. However, new long-term follow-up data from the MEPEX trial suggest that PLEX may not improve survival in these patients.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

References

  1. Holle, J. U. & Gross, W. L. Treatment of ANCA-associated vasculitides (AAV). Autoimmun. Rev. 12, 483–486 (2013).

    Article  Google Scholar 

  2. Walsh, M. et al. Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear. Kidney Int. http://dx.doi.org/10.1038/ki.2013.131.

  3. Klemmer, P. J. et al. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis. Am. J. Kidney Dis. 42, 1149–1153 (2003).

    Article  Google Scholar 

  4. Jayne, D. R. et al. Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J. Am. Soc. Nephrol. 18, 2180–2188 (2007).

    Article  CAS  Google Scholar 

  5. Cole, E. et al. A prospective randomized trial of plasma exchange as additive therapy in idiopathic crescentic glomerulonephritis. The Canadian Apheresis Study Group. Am. J. Kidney Dis. 20, 261–269 (1992).

    Article  CAS  Google Scholar 

  6. McGregor, J. G. et al. Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin. J. Am. Soc. Nephrol. 7, 240–247 (2012).

    Article  CAS  Google Scholar 

  7. Lionaki, S. & Falk, R. J. Removing antibody and preserving glomeruli in ANCA small-vessel vasculitis. J. Am. Soc. Nephrol. 18, 1987–1989 (2007).

    Article  CAS  Google Scholar 

  8. Pepper, R. J. et al. Intravenous cyclophosphamide and plasmapheresis in dialysis-dependent ANCA-associated vasculitis. Clin. J. Am. Soc. Nephrol. 8, 219–224 (2013).

    Article  CAS  Google Scholar 

  9. Walsh, M. et al. Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis. Am. J. Kidney Dis. 57, 566–574 (2011).

    Article  Google Scholar 

  10. Walsh, M. et al. Plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS): protocol for a randomized controlled trial. Trials 14, 73 (2013).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerald B. Appel.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bomback, A., Appel, G. ANCA-associated GN—to PLEX or not to PLEX?. Nat Rev Nephrol 9, 436–438 (2013). https://doi.org/10.1038/nrneph.2013.126

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrneph.2013.126

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing