RESEARCH - Acute glomerulonephritis occurring during immunoadsorption with Prosorba

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Acute glomerulonephritis occurring during immunoadsorption with

staphylococcal protein A column (Prosorba®)

Authors: Iglesias, 1; D'Agati, Vivette D.2; Levine, Jerrold S.3

Source: Nephrology Dialysis Transplantation, Volume 19, Number 12, 15

December 2004, pp. 3155-3159(5)

Abstract:

Background. Apheresis of patient plasma by immunoadsorption with a

staphylococcal protein A (SPA) column is used in a variety of autoimmune

disorders. Leukocytoclastic vasculitis is an uncommon severe complication

that can occur during immunoadsorption with SPA (Prosorba®).

Methods. We report a case of immune complex glomerulonephritis occurring

during Prosorba® immunoadsorption in a patient with rheumatoid arthritis

(RA). Using a Medline literature search and information provided by Cypress

Bioscience/Fresenius Hemocare, we review renal complications associated with

Prosorba® immunoadsorption.

Results. We identified seven additional potential cases of

glomerulonephritis (GN) in association with Prosorba® immunoadsorption. Five

of these patients were being treated for RA, and two for idiopathic

thrombocytopenia purpura (ITP). Renal biopsies were performed on four

patients, all of whom had evidence of immune complex GN. Among RA patients

treated with Prosorba®, the incidence of GN closely paralleled that of

leukocytoclastic vasculitis at 1.75%. The presence of leukocytoclastic

vasculitis was a significant risk factor for the development of GN (relative

risk = 75.95, CI 7-1869, P = 0.00021). In contrast, among more than 10 000

ITP patients treated with Prosorba®, there were only two potential cases of

GN. The risk of developing GN in association with Prosorba® immunoadsorption

was significantly greater for patients with RA than for those with ITP

(relative risk = 62.95, CI 10-453, P = 0.00002).

Conclusion. This case series highlights the risk of GN among patients

undergoing SPA immunoadsorption. The development of GN is associated with

the presence of leukocytoclastic vasculitis. Patients with RA seem to be at

particular risk.

http://www.ingentaconnect.com/content/oup/ndt/2004/00000019/00000012/art03155

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