The Experts below are selected from a list of 41334 Experts worldwide ranked by ideXlab platform
David Jayne - One of the best experts on this subject based on the ideXlab platform.
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Plasma Exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis a meta analysis
American Journal of Kidney Diseases, 2011Co-Authors: Michael Walsh, L. Guillevin, Charles D. Pusey, Fausta Catapano, Wladimir Szpirt, Kristian Thorlund, Annette Bruchfeld, Marion Haubitz, Peter A Merkel, David JayneAbstract:Background Plasma Exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized controlled trials of Plasma Exchange for renal vasculitis. Study Design Systematic review and meta-analysis of articles identified from electronic databases, bibliographies, and studies identified by experts. Data were abstracted in parallel by 2 reviewers. Setting & Population Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis. Selection Criteria for Studies Randomized controlled trials that compared standard care with standard care plus adjuvant Plasma Exchange in adult patients with either renal vasculitis or idiopathic rapidly progressive glomerulonephritis. Intervention Adjuvant Plasma Exchange. Outcome Composite of end-stage renal disease or death. Results We identified 9 trials including 387 patients. In a fixed-effects model, the pooled RR for end-stage renal disease or death was 0.80 for patients treated with adjunctive Plasma Exchange compared with standard care alone (95% CI, 0.65-0.99; P = 0.04). No significant heterogeneity was detected (P = 0.5; I2 = 0%). The effect of Plasma Exchange did not differ significantly across the range of baseline serum creatinine values (P = 0.7) or number of Plasma Exchange treatments (P = 0.8). The RR for end-stage renal disease was 0.64 (95% CI, 0.47-0.88; P = 0.006), whereas the RR for death alone was 1.01 (95% CI, 0.71-1.4; P = 0.9). Limitations Although the primary result was statistically significant, there is insufficient statistical information to reliably determine whether Plasma Exchange decreases the composite of end-stage renal disease or death. Conclusions Plasma Exchange may decrease the composite end point of end-stage renal disease or death in patients with renal vasculitis. Additional trials are required given the limited data available.
Nadine M. Benador - One of the best experts on this subject based on the ideXlab platform.
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Therapeutic Plasma Exchange for the treatment of pediatric renal diseases in 2013
Pediatric Nephrology, 2014Co-Authors: Caitlin E. Carter, Nadine M. BenadorAbstract:Therapeutic Plasma Exchange is an extracorporeal treatment modality that removes systemic circulating pathologic factors or replaces absent Plasma components and plays a role in many nephrologic conditions. It presents a number of technical challenges in the pediatric population but has become an increasingly common practice in pediatric nephrology over the past several decades. While prospective evidence is often lacking, our increased understanding of the molecular pathogenesis underlying many pediatric renal diseases provides sound reasoning for the use of Plasma Exchange in treating these conditions. This review will present the currently accepted indications for Plasma Exchange in children, the technical aspects of the procedure and its potential complications.
Rama C Nair - One of the best experts on this subject based on the ideXlab platform.
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cryosupernatant as replacement fluid for Plasma Exchange in thrombotic thrombocytopenic purpura
British Journal of Haematology, 1996Co-Authors: G Rock, Kenneth H Shumak, David Sutton, Noel A Buskard, Rama C NairAbstract:The current established treatment of thrombotic thrombocytopenic purpura (TTP) is Plasma Exchange with fresh frozen Plasma (FFP). With this treatment, there is a 49% response after seven Exchanges and a 78% survival at 1 month. Although the exact cause of TTP is unknown, the presence of von Willebrand factor (VWF) multimers has been implicated in the disease. Accordingly, it has been suggested that cryosupernatant (Plasma from which cryoprecipitate has been removed), which is relatively deficient in VWF multimers, might be an effective replacement fluid during Plasma Exchange. Patients from six centres were treated by Plasma Exchange with cryosupernatant. 18 patients who had failed a first course (average 7.7 Exchanges) of Plasma Exchange with FFP, received a further seven Exchanges with cryosupernatant. Subsequently, 40 previously untreated patients were Exchanged with cryosupernatant. Of the 18 previously treated patients, 11 responded (defined as an increase in platelet count to >150 × 109/l and no neurological events) after seven Exchanges and 15 (83%) of the patients were alive at 1 month. The response rate in the 40 previously untreated patients was 75% at the end of seven Exchanges and 95% of the patients were alive at 1 month. These values are significantly different (P<0.05) from those reported in our earlier study and in other patients concurrently treated at the same centres with FFP when cryosupernatant was not available. Some patients who have failed to respond to Plasma Exchange with FFP replacement will respond to further Exchange with cryosupernatant. Cryosupernatant replacement may be more effective as first-line treatment of TTP than FFP.
Michael Walsh - One of the best experts on this subject based on the ideXlab platform.
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Plasma Exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis a meta analysis
American Journal of Kidney Diseases, 2011Co-Authors: Michael Walsh, L. Guillevin, Charles D. Pusey, Fausta Catapano, Wladimir Szpirt, Kristian Thorlund, Annette Bruchfeld, Marion Haubitz, Peter A Merkel, David JayneAbstract:Background Plasma Exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized controlled trials of Plasma Exchange for renal vasculitis. Study Design Systematic review and meta-analysis of articles identified from electronic databases, bibliographies, and studies identified by experts. Data were abstracted in parallel by 2 reviewers. Setting & Population Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis. Selection Criteria for Studies Randomized controlled trials that compared standard care with standard care plus adjuvant Plasma Exchange in adult patients with either renal vasculitis or idiopathic rapidly progressive glomerulonephritis. Intervention Adjuvant Plasma Exchange. Outcome Composite of end-stage renal disease or death. Results We identified 9 trials including 387 patients. In a fixed-effects model, the pooled RR for end-stage renal disease or death was 0.80 for patients treated with adjunctive Plasma Exchange compared with standard care alone (95% CI, 0.65-0.99; P = 0.04). No significant heterogeneity was detected (P = 0.5; I2 = 0%). The effect of Plasma Exchange did not differ significantly across the range of baseline serum creatinine values (P = 0.7) or number of Plasma Exchange treatments (P = 0.8). The RR for end-stage renal disease was 0.64 (95% CI, 0.47-0.88; P = 0.006), whereas the RR for death alone was 1.01 (95% CI, 0.71-1.4; P = 0.9). Limitations Although the primary result was statistically significant, there is insufficient statistical information to reliably determine whether Plasma Exchange decreases the composite of end-stage renal disease or death. Conclusions Plasma Exchange may decrease the composite end point of end-stage renal disease or death in patients with renal vasculitis. Additional trials are required given the limited data available.
Bernd C. Kieseier - One of the best experts on this subject based on the ideXlab platform.
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Plasma Exchange in immune-mediated neuropathies.
Current Opinion in Neurology, 2008Co-Authors: Helmar C. Lehmann, Hans-peter Hartung, Gerd Meyer Zu Hörste, Bernd C. KieseierAbstract:PURPOSE OF REVIEW Plasma Exchange is frequently used for treatment of immune-mediated neuropathies. Here, we review the current value of Plasma Exchange in the treatment of different forms of immune-mediated neuropathies and discuss latest developments. RECENT FINDINGS Plasma Exchange is used in various disease conditions; however, of all immune-mediated disorders of the peripheral nerve, Guillain-Barre syndrome represents the disease entity in which short and long-term efficacy, optimal frequency, side effects and cost effectiveness of Plasma Exchange are best documented. Although randomized trials evaluated the value of Plasma Exchange in chronic forms of immune-neuropathies, its long-term efficacy and its optimal frequency still remain unclear. SUMMARY Especially in chronic forms of immune-mediated neuropathies, Plasma Exchange needs to be further evaluated in clinical trials to assess long-term efficacy and its potential as adjuvant treatment option.
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Plasma Exchange in neuroimmunological disorders part 1 rationale and treatment of inflammatory central nervous system disorders
JAMA Neurology, 2006Co-Authors: Helmar C. Lehmann, Hans-peter Hartung, Gerd R Hetzel, Olaf Stuve, Bernd C. KieseierAbstract:Plasma Exchange is a well-established therapeutic procedure commonly used in many neurological disorders of autoimmune etiology. It is thought that the beneficial effects of Plasma Exchange occur through the elimination of pathognomonic inflammatory mediators, including autoantibodies, complement components, and cytokines. In various neurological disorders, randomized controlled studies have demonstrated the efficacy of Plasma Exchange (eg, in Guillain-Barre syndrome and other forms of immune neuropathies). Although widely used, the potential benefit of Plasma Exchange in the treatment of multiple sclerosis, myasthenia gravis, and Lambert-Eaton syndrome is less clear.