Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Journal of Clinical Apheresis, Год журнала: 2023, Номер 38(2), С. 77 - 278

Опубликована: Апрель 1, 2023

The American Society for Apheresis (ASFA) Journal of Clinical (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications the evidence-based use therapeutic apheresis (TA) in human disease. In Ninth Edition, JCA has incorporated systematic review approaches grading evidence categorization to make recommendations on a wide variety diseases conditions. This edition largely maintained general layout concept fact sheet introduced Fourth Edition (2007). Each succinctly summarizes TA specific disease or medical condition. comprises 91 sheets 166 graded categorized indications. includes seven new sheets, nine existing eight changes category seeks continue serve as key resource that guides utilization treatment

Язык: Английский

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IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome

Pediatric Nephrology, Год журнала: 2020, Номер 35(8), С. 1529 - 1561

Опубликована: Май 7, 2020

Abstract Idiopathic nephrotic syndrome newly affects 1–3 per 100,000 children year. Approximately 85% of cases show complete remission proteinuria following glucocorticoid treatment. Patients who do not achieve within 4–6 weeks treatment have steroid-resistant (SRNS). In 10–30% patients, mutations in podocyte-associated genes can be detected, whereas an undefined circulating factor immune origin is assumed the remaining ones. Diagnosis and management SRNS a great challenge due to its heterogeneous etiology, frequent lack by further immunosuppressive treatment, severe complications including development end-stage kidney disease recurrence after renal transplantation. A team experts pediatric nephrologists geneticists from International Pediatric Nephrology Association (IPNA), pathologist, adult nephrologist now developed comprehensive clinical practice recommendations on diagnosis children. The performed systematic literature review 9 clinically relevant PICO ( P atient or opulation covered, I ntervention, C omparator, O utcome) questions, formulated formally graded them at consensus meeting, with input patient representatives dietician acting as external advisors voting panel nephrologists. Research are also given.

Язык: Английский

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Molecular stratification of idiopathic nephrotic syndrome

Nature Reviews Nephrology, Год журнала: 2019, Номер 15(12), С. 750 - 765

Опубликована: Окт. 25, 2019

Язык: Английский

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The role of the immune system in idiopathic nephrotic syndrome

Molecular and Cellular Pediatrics, Год журнала: 2021, Номер 8(1)

Опубликована: Ноя. 18, 2021

Abstract Idiopathic nephrotic syndrome (INS) in children is characterized by massive proteinuria and hypoalbuminemia usually responds well to steroids. However, relapses are frequent, which can require multi-drug therapy with deleterious long-term side effects. In the last decades, different hypotheses on molecular mechanisms underlying INS have been proposed several lines of evidences strongly indicate a crucial role immune system pathogenesis non-genetic INS. traditionally considered T-cell-mediated disorder triggered circulating factor, causes impairment glomerular filtration barrier subsequent proteinuria. Additionally, imbalance between Th17/Tregs as Th2/Th1 has implicated pathomechanism Interestingly, B-cells gained attention, since rituximab, an anti-CD20 antibody demonstrated good therapeutic response treatment Finally, recent findings that even podocytes act antigen-presenting cells under inflammatory stimuli play direct activating cellular pathways cause Even though our knowledge still incomplete, it became clear instead cell subset or one particular molecule causative factor for INS, multi-step control including soluble factors, cells, necessary prevent occurrence This present review aims provide overview current this topic, advances understanding immunopathogenesis may help drive new tailored approaches forward.

Язык: Английский

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Clinical practice recommendations for recurrence of focal and segmental glomerulosclerosis/steroid‐resistant nephrotic syndrome

Pediatric Transplantation, Год журнала: 2020, Номер 25(3)

Опубликована: Дек. 30, 2020

Recurrence of primary disease is one the major risks for allograft loss after pediatric RTx. The risk recurrence FSGS/SRNS RTx in particular can be up to 86% idiopathic cases. There a need consensus recommendations on its prevention and treatment. CERTAIN study group has therefore performed thorough literature search based PICO model clinical questions formulate educated statements guide clinician process decision-making. A set treatment been generated careful evaluation available evidence panel discussion. We do not recommend routine nephrectomy prior transplantation; neither we abstaining from living donation. Special attendance needs given those patients who had already experienced graft due recurrence. Early PE or IA with without high-dose CsA and/or rituximab seems most promising induce remission. presented here acknowledge that remains concern associated shorter survival even loss. value any recommendation take into account cohorts differ ethnicity, pre-transplant history, immunosuppressive regimen, definition (eg, histological diagnosis) modalities

Язык: Английский

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Focal segmental glomerulosclerosis: Risk for recurrence and interventions to optimize outcomes following recurrence

Pediatric Transplantation, Год журнала: 2022, Номер 26(6)

Опубликована: Май 19, 2022

Abstract Background FSGS is a common indication for kidney transplant with high‐risk of posttransplant recurrence. Methods In this review, we summarize current knowledge about recurrence after transplantation, including epidemiology, pretransplant planning, management, and investigational treatments. Results recurs in 14%–60% first transplants, likely associated circulating permeability factor. Pretransplant counseling regarding critical, patients should undergo genetic screening. Rapid progression to ESKD, initial steroid responsiveness, younger age at diagnosis, race/ethnicity, mesangial hypercellularity or minimal change histology on native biopsy may be Living donation not contraindicated but does result improved graft survival relative deceased donation. nephrectomy performed variety reasons, decrease therapy rituximab and/or PE understudied clearly effective preventing Patients typically present early rapid‐onset severe proteinuria. Diagnosis can confirmed by showing foot process effacement; typical lesions are seen light microscopy the stages. There no established treatment recurrent FSGS, renin–angiotensin–aldosterone system inhibition extracorporeal therapies, IA, most commonly used. Adjunct alternative therapies include rituximab, lipopheresis, cyclosporine.

Язык: Английский

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Therapeutic apheresis in kidney diseases: an updated review

Renal Failure, Год журнала: 2022, Номер 44(1), С. 842 - 857

Опубликована: Июнь 19, 2022

Besides conventional medical therapies, therapeutic apheresis has become an important adjunctive or alternative option to immunosuppressive agents for primary secondary kidney diseases and transplantation. The available techniques used in diseases, including plasma exchange, double-filtration plasmapheresis, immunoadsorption, low-density lipoprotein apheresis. Plasma exchange is still the leading extracorporeal therapy. Recently, growing evidence supports potential benefits of plasmapheresis immunoadsorption more specific effective clearance pathogenic antibodies with fewer side effects. However, randomized controlled trials are needed. Low-density also supplementary therapy patients recurrent focal segmental glomerulosclerosis. This review collects latest from recent studies, focuses on advantages disadvantages these techniques, compares discrepancy among them determine optimal regimens certain diseases.

Язык: Английский

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Post-transplant recurrence of focal segmental glomerular sclerosis: consensus statements

Kidney International, Год журнала: 2023, Номер 105(3), С. 450 - 463

Опубликована: Дек. 22, 2023

Focal segmental glomerular sclerosis (FSGS) is 1 of the primary causes nephrotic syndrome in both pediatric and adult patients, which can lead to end-stage kidney disease. Recurrence FSGS after transplantation significantly increases allograft loss, leading morbidity mortality. Currently, there are no consensus guidelines for identifying those patients who at risk recurrence or management recurrent FSGS. Our work group performed a literature search on PubMed/Medline, Embase, Cochrane, recommendations were proposed graded strength evidence. Of 614 initially identified studies, 221 found suitable formulate These focus definition, epidemiology, factors, pathogenesis, We conclude that additional studies required strengthen this review.

Язык: Английский

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Recurrent Focal Segmental Glomerulosclerosis Post Renal Transplantation

IntechOpen eBooks, Год журнала: 2025, Номер unknown

Опубликована: Фев. 27, 2025

Focal segmental glomerulosclerosis (FSGS) is a major cause of nephrotic syndrome in children and adults, presenting significant clinical challenge due to its high post-transplant recurrence rate negative impact on graft survival. The pathophysiology recurrent FSGS (rFSGS) involves complex interplay between circulating permeability factors podocyte signaling pathways, leading actin cytoskeleton disorganization glomerular filtration barrier dysfunction. This review explores the epidemiology, risk factors, pathogenic mechanisms rFSGS, focusing central role podocytes their intricate molecular architecture. Emerging biomarkers potential therapeutic strategies are also discussed, based our current understanding disease. Further studies needed fully elucidate precise develop targeted therapies improve outcomes patients with rFSGS.

Язык: Английский

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Low Density Lipoprotein Apheresis for Treatment of Focal Segmental

Hemodialysis International, Год журнала: 2025, Номер unknown

Опубликована: Март 2, 2025

ABSTRACT Focal segmental glomerulosclerosis (FSGS) has become one the leading causes of kidney disease in United States. With incidence FSGS rising over past decade, capable treatment options have been a large focus research. One therapy that shows promise is low density lipoprotein apheresis (LDL‐A). This procedure removes lipoproteins containing apolipoprotein‐B from blood, thus reducing lipid load on renal system. LDL‐A also improves responsiveness to standard corticosteroids and cyclosporine. paper describes current techniques, offers insight existing clinical studies employing this therapy, ultimately highlights as option for FSGS, post‐renal transplant, nephrotic syndrome.

Язык: Английский

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