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François Madore - One of the best experts on this subject based on the ideXlab platform.
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Plasmapheresis
DeckerMed Nephrology Dialysis and Transplantation, 2017Co-Authors: François MadoreAbstract:Plasmapheresis has been applied over the last several decades as primary or adjunctive treatment for a number of primary renal diseases and systemic conditions with renal involvement. The present review discusses renal conditions for which Plasmapheresis may be attempted with recommendations based on evidence from the literature. Other indications of special interest for renal physicians (e.g., sepsis and multiple organ failure, drug overdose, and poisoning) are also discussed. In addition, the present text reviews general apheresis principles, technical considerations for optimal Plasmapheresis prescription, and possible complications of Plasmapheresis. Knowledge of disease mechanisms and Plasmapheresis principles is invaluable in applying a Plasmapheresis treatment regimen appropriately.
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Plasmapheresis in Acute Intoxication and Poisoning
Critical Care Nephrology, 2009Co-Authors: François MadoreAbstract:Abstract The chapter will: 1. Present an overview of the possible mechanisms of action of Plasmapheresis in poisoning and drug overdose. 2. Review the pharmacokinetic factors that affect the elimination of poisons/drugs by Plasmapheresis. 3. Highlight the limitations of published studies on the efficacy of Plasmapheresis in poisoning and drug overdose. 4. Summarize published data on the efficacy of Plasmapheresis for specific poisons and drugs.
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Plasmapheresis. Technical aspects and indications.
Critical care clinics, 2002Co-Authors: François MadoreAbstract:In summary, use of Plasmapheresis has changed in recent years given advances in medical technology that have allowed a wider clinical application in the critical care setting. Membrane filtration technology has provided an alternative to centrifugation that can be easily applied in intensive care units. Use of Plasmapheresis has also changed in recent years reflecting the availability of evidence largely obtained from controlled prospective studies. However, the clinical efficacy of Plasmapheresis for many acute renal conditions is still controversial. Plasmapheresis appears to be a useful adjunct to conventional therapy in the treatment of anti-GBM nephritis, severe dialysis-dependent forms of pauciimmune RPGN, cryoglobulinemia, and HUS-TTP. Reported data also suggest a possible benefit of Plasmapheresis in patients with myeloma cast nephropathy, sepsis, and poisoning/overdose, but the case for Plasmapheresis in these disorders is largely unproven and the reported evidence insufficient to recommend its use outside research settings. In contrast, data from controlled trials do not support a role for Plasmapheresis in immune complex-mediated RPGN, such as lupus nephritis, and acute allograft rejection. The more widespread application of prospective, randomized, controlled clinical trials should help to better define the value of Plasmapheresis for treatment of acute renal diseases.
Piotr Milkiewicz - One of the best experts on this subject based on the ideXlab platform.
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Plasmapheresis exerts a long lasting antipruritic effect in severe cholestatic itch
Liver International, 2017Co-Authors: Marcin Krawczyk, Roman Liebe, Michal Wasilewicz, Ewa Wunsch, Joanna Raszejawyszomirska, Piotr MilkiewiczAbstract:BACKGROUND & AIMS: The amelioration of refractory cholestatic pruritus after Plasmapheresis has been reported in single patients. Here, we analyse the efficacy of Plasmapheresis in a cohort of patients with primary biliary cholangitis (PBC). METHODS: Seventeen consecutive patients with PBC (age range 39-85 years, 16 females, 9 with cirrhosis) and refractory pruritus underwent 129 Plasmapheresis procedures during 40 admissions. Pruritus was quantified by the 10-point numeric rating scale (NRS) before and after Plasmapheresis, as well as ~30 and ~90 days later. RESULTS: The mean pruritus before Plasmapheresis did not differ between patients with and without cirrhosis (P>.05). Cirrhotics presented, however, with significantly higher serum alanine aminotransferase (ALT), aspartate transaminase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP) and bilirubin before Plasmapheresis. Plasmapheresis decreased itching to NRS≤5 in all but five admissions: Mean pruritus decreased from 8.3±1.4 to 3.1±2.2 (P<.0001) in the entire cohort. It also led to a significant decrease in serum ALT, ALP, AST, GGT (all P<.001) and bilirubin (P=.002). Antipruritic effect persisted throughout the 90-days follow-up (P<.0001). The amelioration of pruritus was not affected by the presence of cirrhosis. CONCLUSIONS: Plasmapheresis is a promising method for reducing intractable itch in a significant proportion of PBC patients regardless of liver fibrosis. Long-lasting improvement of symptoms requires repeated procedures.
Bruce Kaplan - One of the best experts on this subject based on the ideXlab platform.
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Removal of basiliximab by Plasmapheresis.
American Journal of Kidney Diseases, 2009Co-Authors: Chike Nathan Okechukwu, Herwig Ulf Meier-kriesche, Doug Armstrong, Christophe Gerbeau, Darrell A. Campbell, Bruce KaplanAbstract:: Basiliximab is a chimeric monoclonal antibody directed against the alpha chain of interleukin-2 (IL-2) receptors. Given its expected volume of distribution (plasma volume), therapeutic Plasmapheresis may be expected to lower serum Basiliximab levels. A 20-mg dose of Basiliximab was given before Plasmapheresis. Blood and pheresis fluid samples were obtained to monitor Basiliximab levels. A total of three blood samples were drawn: the first was obtained 4 hours before, the second sample immediately before commencement, and the third 2 hours after cessation of Plasmapheresis. A fourth sample was obtained from the removed plasma. There was an appreciable reduction in Basiliximab concentration levels after Plasmapheresis. From the change in serum concentration after Plasmapheresis, approximately 64.6% of circulating Basiliximab was removed. Plasmapheresis removes substantial amounts of Basiliximab. Therefore, supplemental Basiliximab should be given after Plasmapheresis to maintain the desired duration of IL-2R saturation.
Richard C. Friedberg - One of the best experts on this subject based on the ideXlab platform.
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Removal of Vancomycin during Plasmapheresis
The Annals of pharmacotherapy, 1997Co-Authors: Syble D. Mcclellan, Charles H Whitaker, Richard C. FriedbergAbstract:OBJECTIVE:To examine the removal of vancomycin during Plasmapheresis, determine whether drug administration should be withheld prior to or a supplemental dose given after the procedure, and determine whether a redistribution phenomenon in vancomycin serum concentrations occurs after Plasmapheresis.DESIGN:Prospective, cohort study.SETTING:An 800-bed, tertiary-care, teaching hospital.PATIENTS:Twelve patients receiving vancomycin as prescribed who were also undergoing therapeutic Plasmapheresis.METHODS:Blood samples for determination of vancomycin concentrations were obtained from each patient immediately before, during, immediately after, and 2 hours after Plasmapheresis. Vancomycin concentration in plasma removed by Plasmapheresis and volume of plasma removed were measured. Patient-specific pharmacokinetic parameters were determined for each patient using serum concentration data and a one-compartment model. Percent of drug removed by Plasmapheresis and percent increase in vancomycin total clearance second...
Walter H Dzik - One of the best experts on this subject based on the ideXlab platform.
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light chain removal by Plasmapheresis in myeloma associated renal failure
Transfusion, 2007Co-Authors: Christine M Cserti, Richard L Haspel, Christopher P Stowell, Walter H DzikAbstract:Background Although Plasmapheresis has been recommended to reverse nephrotoxic elevations of serum free light chains (sFLCs), there are scant published data on removal of sFLC measured with modern assays. Study design and methods sFLC levels were recorded in two patients with myeloma-associated renal failure receiving multiple Plasmapheresis procedures. Results In one patient, presenting with acute renal failure 8 months after diagnosis of kappa-LC myeloma, 16 Plasmapheresis procedures neither reduced sFLC levels (percent removal ranging from -70% to +40%) nor improved renal function. In another patient who presented with leukemic immunoglobulin A-lambda myeloma and acute renal failure, sFLC decreased by 30 to 60 percent after each Plasmapheresis procedure, but rebounded within 5 to 10 hours. Renal failure occurred despite Plasmapheresis, and hemodialysis was required. Conclusions In both patients, Plasmapheresis failed to effectively lower sFLC levels. The results provide initial biologic data supporting the conclusions of a recent randomized multicenter clinical trial in which Plasmapheresis was an ineffective adjunct to chemotherapy for myeloma-associated acute renal failure.
