The effect of
plasmapheresis(PP) monotherapy and PP with
corticosteroid administration were evaluated in a male with crescentic
glomerulonephritis(CrGN). On the first admission, since he was positive for both anti-neutrophil cytoplasmic myeloperoxydase
autoantibody(MPO-
ANCA) and circulating
immune complex(IC), the treatment was started with PP alone to reduce these
autoantibodies immediately. During two months, three series of PP were performed: three sessions of
plasma exchange (PEX) with fresh frozen plasma(FFP), two sessions of
double filtration plasmapheresis(DFPP), and then, another two sessions of PEX, respectively.
ANCA remained suppressed for 4 weeks after the first series of PEX, and increased thereafter. Subsequent DFPP caused a rebound of
ANCA titer while the second PEX suppressed
ANCA, at least, for 1 week. Though
creatinine clearance(Ccr) improved after the first PEX and this level was maintained,
ANCA increased again after the second PEX. Therefore the patient was treated with methyl-
prednisolone(m-PSL) semipulse
therapy followed by mild cocktail
therapy including
prednisolone(PSL) at 20 mg/day and
mizoribine at 100 mg/day. In two weeks,
ANCA and IC became negative and Ccr improved further. When PSL was tapered off, the
ANCA became positive again. Since
ANCA was not suppressed and Ccr declined gradually even after re-administration of oral PSL at 30-40 mg/day, PP was superimposed on
steroid therapy with 3 sessions of DFPP and PEX, respectively. Ccr was improved, but
ANCA was not sufficiently decreased by DFPP. Subsequent PEX was more efficient than DFPP in reducing the
ANCA level. However, m-PSL semipulse was eventually required for complete suppression of
ANCA. Thus PP was partially effective, but not sufficient as monotherapy. However it was considered advantageous as an adjunct
therapy to reduce the dose of immunosuppressive drugs in CrGN. As to the mode of PP, PEX with FFP appeared to be more effective than DFPP in reducing the plasma
ANCA level.