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Dialyse aktuell 2015; 19(4): 207-212
DOI: 10.1055/s-0035-1554095
Dialyse
© Georg Thieme Verlag Stuttgart · New York

Aphereseverfahren bei Nierenerkrankungen und Nierentransplantation – Der aktuelle Stand des Wissens

Apheresis in kidney diseases and kidney transplantation – The current state of knowledge
Bernd Hohenstein
1   Bereich Nephrologie, Medizinische Klinik III mit Poliklinik, Universitätsklinikum Carl Gustav Carus, Dresden (Bereichsleitung: Prof. Dr. Christian Hugo)
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Publication Date:
19 May 2015 (online)

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Die Evidenz für den Einsatz von Aphereseverfahren bei nephrologischen Erkrankungen ist stark vom Krankheitsbild und deren Akuität abhängig. Für eine Reihe nephrologischer Erkrankungen ergeben sich damit klare Indikationen für die Anwendung eines Aphereseverfahrens. Hierzu gehören die ANCA–assoziierten Vaskulitiden, bei denen in Fällen der schwerer Nierenbeteiligung (Serum-Kreatinin-Wert > 500 μmol/l bzw. > 5,8 mg/dl) sowie schwerer pulmonaler Beteiligung der therapeutische Plasmaersatz durchgeführt werden sollte. Gleichermaßen ist diese Behandlung bei der Anti-GBM-Erkrankung, der kryoglobulinämischen Vaskulitis und dem Hyperviskositätssyndrom etabliert. Thrombotische Mikroangiopathien sollten bis zur Differenzierung der Pathogenese mittels TPE anbehandelt, bei der Diagnose eines aHUS aber mit Eculizumab weiterbehandelt werden. Im Rahmen der Nierentransplantation spielen Aphereseverfahren für die Vorbereitung AB0–inkompatibler Transplantationen und vermutlich auch bei der Therapie akuter humoraler Abstoßungsreaktionen eine Rolle. Dagegen gibt es für andere Krankheitsbilder wie den SLE mit Lupusnephritis und das nephrotische Syndrom oder die fokal-segmentale Glomerulosklerose (FSGS) Hinweise auf eine Wirksamkeit der Apherese, welche aber letztlich im Rahmen eines individuellen Heilversuchs eingesetzt werden kann. Perspektivisch könnte die Apherese aber auch bei anderen schwer verlaufenden nephrologischen Krankheitsbildern eine Anwendung finden.

Availability of evidence for the application of apheresis for the treatment of renal disorders depends on the type of renal disease and its acuity. Apheresis has a clear indication in a variety of renal disorders. Typically, ANCA-associated vasculitis with severe renal injury (defined as serum creatinine > 500 μmol/l or > 5.8 mg/dl) or severe lung injury should be treated with therapeutic plasma exchange (TPE). Other clear indications represent anti-GBM disease, cryoglobulinemic vasculitis and hyperviscosity syndrome. Thrombotic microangiopathies should undergo TPE until their pathogenesis is further clarified and a decision can be made to either use eculizumab in cases of atypical haemolytic-uremic syndrome (aHUS) or continue TPE. Apheresis techniques are frequently used during recipients' preparation for AB0-incompatible kidney transplantation and might also play a relevant role in the treatment of acute humoral graft rejection. On the other hand, there are diseases like lupus nephritis, some cases of nephrotic syndrome and also focal segmental glomerular sclerosis (FSGS) in which apheresis could be effective, but should only be used for individualized healing approaches. Perspectively, apheresis might also have a role in other severe (and mainly acute) forms of renal disease.

Key words

apheresis - immunoadsorption - kidney disease - glomerulonephritis - kidney transplantation
 

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