Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Kidney Dis. 2023 Apr;81(4):475-492. doi: 10.1053/j.ajkd.2022.10.017. Epub 2023 Feb 10.
From producing individual blood components for transfusion to the removal of pathogenic substances, apheresis is a cornerstone of modern medical therapies. The use of therapeutic plasma exchange (TPE), in which plasma and its soluble constituents are removed from the body in exchange for a replacement fluid, can be organ- and life-saving in many diseases. Given the notable similarities between TPE and hemodialysis, the nephrologist is often responsible for managing TPE. As such, one must be familiar with the technologies, approach to therapy, indications for use, and complications. TPE uses centrifugation or membrane separation technologies, with the latter able to be performed with certain hemodialysis machines familiar to the nephrologist. Furthermore, primary kidney diseases such as anti-glomerular basement membrane disease are frequently associated with autoantibodies, potentially making them ideal candidates for TPE. Nevertheless, the use of TPE in many kidney diseases is controversial because of the lack of supporting evidence. This review discusses TPE from the perspective of a nephrologist responsible for prescribing and managing TPE, as well as nephrologists engaged in the care of patients undergoing the procedure.
从生产用于输血的单个血液成分到去除致病物质，单采是现代医学治疗的基石。治疗性血浆置换 (TPE) 的应用，其中从体内去除血浆及其可溶性成分，并以替代液进行交换，可以在许多疾病中挽救器官和生命。鉴于 TPE 和血液透析之间的显著相似性，肾脏病学家通常负责管理 TPE。因此，必须熟悉技术、治疗方法、适应证和并发症。TPE 使用离心或膜分离技术，后者可以在肾脏病学家熟悉的某些血液透析机上进行。此外，原发性肾脏疾病，如抗肾小球基底膜疾病，常与自身抗体有关，使其成为 TPE 的理想候选者。然而，由于缺乏支持证据，TPE 在许多肾脏疾病中的应用存在争议。本文从负责开处方和管理 TPE 的肾脏病学家以及参与接受该程序治疗的患者护理的肾脏病学家的角度讨论 TPE。
