Coppo R, Basolo B, Roccatello D, Giachino O, Lajolo D, Martina G, Rollino C, Amore A, Costa M, Piccoli G
Int J Artif Organs. 1985 Jul;8 Suppl 2:55-8.
Five patients with progressive primary IgA nephropathy (PIgAGN) were treated by plasma-exchange (PE) combined with immunosuppressive drugs. Circulating IgA-containing immune complexes (IgAIC), detected by a specific conglutinin solid phase assay, were monitored. Two patients with acute nephritic syndrome and rapidly progressing course, crescent formations and high levels of IgAIC had substantial lasting clinical improvement after several PE, with a fall in IgAIC levels. Another rapidly progressive case with marked sclerotic changes and a longer history of nephritic syndrome, but with normal levels of IgAIC, did not show any clinical improvement after PE. Two patients with a PIgAGN diagnosed several years before and presenting slowly evolutive course had no substantial clinical benefit from PE treatment. IgAIC levels, very high before PE temporarily decreased, but returned to the previous values after the end of the treatment. We conclude that PE combined with immunosuppressive treatment may be of clinical benefit for cases with acute nephritic syndrome of recent onset who still have high levels of IgAIC, even when important crescent formations are present.
五例进行性原发性IgA肾病（PIgAGN）患者接受了血浆置换（PE）联合免疫抑制药物治疗。通过特异性凝集素固相分析法检测循环中含IgA的免疫复合物（IgAIC）并进行监测。两名患有急性肾炎综合征且病程进展迅速、有新月体形成和高水平IgAIC的患者，在多次PE治疗后临床症状有显著且持久的改善，IgAIC水平下降。另一例快速进展病例有明显的硬化改变且肾炎综合征病史较长，但IgAIC水平正常，PE治疗后未显示出任何临床改善。两名数年前诊断为PIgAGN且病程缓慢进展的患者，PE治疗未获得实质性临床益处。PE治疗前非常高的IgAIC水平暂时降低，但治疗结束后又恢复到先前值。我们得出结论，对于近期起病的急性肾炎综合征且仍有高水平IgAIC的病例，即使存在重要的新月体形成，PE联合免疫抑制治疗可能具有临床益处。
