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      Clinical Outcome of Patients with Wegener’s Granulomatosis Treated with Plasma Exchange

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          We report the clinical course of 29 patients with Wegener’s granulomatosis (WG) treated with plasma exchange (PE) in Norway in the period from 1988 to 1999. Median follow-up was 41.5 months. The mean number of exchanges was 8.5 ± 5.8 (range 2–32). Median serum creatinine concentration was 400 µmol/l (range 90–1,356) and 17 patients were dialysis dependent at presentation. Two- and five-year patient survival was 75 and 71%, respectively, and renal (ESRD-free) survival was 74 and 54%, respectively. Seven (50%) of the 14 patients alive in the dialysis group had discontinued dialysis within the first month, and 6 (50%) of 12 patients alive at follow-up had independent renal function. No patients, however, had normal serum creatinine concentration. Median time until development of ESRD for patients presenting with a need for dialysis was ∼32 months. The development of ESRD in 79 patients treated with immunosuppression alone was significantly lower, but when adjusted for serum creatinine there was no difference between patients treated with or without PE. Although a considerable fraction of patients with WG and severe renal involvement regain independent renal function, few will have normal serum creatinine concentration at follow-up, despite the addition of PE as adjunctive therapy.

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          Most cited references 4

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          Complications of plasma exchange.

           D. Sutton,  M G Rock,  R Nair (1989)
          For the past few years, the Canadian Apheresis Study Group has collected data on most apheresis procedures carried out throughout the country. The information accumulated during calendar year 1985 has been reviewed, and the complications that occurred as a result of therapeutic plasma exchange (PE) have been assessed. There were side effects during 612 (12%) of the 5235 procedures done, involving 252 (40%) of the 627 patients treated. The most common reactions were fever, chills, urticaria, muscle cramps, or paresthesias; these reactions were encountered more frequently when plasma was used in the replacement fluid. Most reactions had little or no clinical significance. However, there were 28 severe complications, including one cardiac arrest and two respiratory arrests. Five late deaths occurred, but these were not related directly to PE. Although PE is relatively safe, life-threatening reactions do occur, and patients require careful observation during the procedure.
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            Direct nucleation of calcium oxalate dihydrate crystals onto the surface of living renal epithelial cells in culture.

            The interaction of the most common crystal in human urine, calcium oxalate dihydrate (COD), with the surface of monkey renal epithelial cells (BSC-1 line) was studied to identify initiating events in kidney stone formation.
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              Animal models of anti-neutrophil cytoplasmic antibody associated vasculitis.


                Author and article information

                Blood Purif
                Blood Purification
                S. Karger AG
                30 January 2002
                : 20
                : 2
                : 167-173
                aDepartment of Medicine, University Hospital of Trondheim; The Norwegian Kidney Register, bInstitute of Medicine, cDepartment of Pathology, Haukeland University Hospital, Bergen, Norway
                47004 Blood Purif 2002;20:167–173
                © 2002 S. Karger AG, Basel

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                Page count
                Figures: 3, Tables: 2, References: 32, Pages: 7
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/47004
                Original Paper


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