scholarly journals Purtscher-like retinopathy in a 56-year-old Thai female with anti-glomerular basement membrane glomerulonephritis

2016 ◽  
Vol 14 (3) ◽  
pp. 129-136
Author(s):  
Supalert Prakhunhungsit ◽  
Rossukon Khotcharrat
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Basement Membrane ◽  
Plasma Exchange ◽  
Creatinine Level ◽  
Glomerular Basement Membrane ◽  
Anterior Segment ◽  
University Hospital ◽  
Total Plasma ◽  
Total Plasma Exchange

A 56-year-old Thai female was referred to Naresuan university hospital with anemia and pitting edema both legs. She had underlying diseases of hypertension, hypercholesterolemia and chronic renal failure with anemia. Before her referral, she was treated by an internist at a provincial hospital. With deterioration of creatinine level and anemic symptom, she was advised to see a nephrologist for the diagnosis of causative pathology and treatment. The reevaluation of chronic renal failure was done. The results of laboratory investigation were creatinine level of 2.42 mg/dl, blood urea nitrogen (BUN) 44 mg/dl and the urinalysis found microscopic hematuria. Further evaluations for hematuria ; vaginoscopy, cystoscopy and ultrasonography of genitourinary system, were performed consequently but all investigations were unremarkable. Then, renal biopsy was done with the result of anti-glomerular basement membrane glomerulonephritis. The hemodialysis and total plasma exchange were done several times to reduce the antibody of anti glomerular basement membrane level.During her admission, she complained of sudden blurred vision both eyes after the ninth total plasma exchange. She has no previous ocular problems nor physical trauma. The ocular examination showed visual acuity of counting fingers both eyes. Anterior segment was unremarkable for her age. The posterior segments showed retinal thickening around the posterior poles with clear intervening zones both eyes with some intraretinal hemorrhage which was compatible with Purtscher-like retinopathy by clinical. The pathogenesis of Purtscher-like retinopathy was investigated with negative results. The counseling was done and the treatment of observation was chosen by the patient and her family. Then she was discharged and followed up at out patient unit of ophthalmology department, Naresuan university hospital.   Conclusion: The Purtscher-like retinopathy is a rare ocular disease with  variable treatment strategies and outcomes. In complicated case without obvious causes, the pathogenesis of the disease should be investigated which directed to the proper treatment and better visual outcome.

Removal of elevated circulating angiopoietin-2 by plasma exchange – A pilot study in critically ill patients with thrombotic microangiopathy and anti-glomerular basement membrane disease

2010 ◽  
Vol 104 (11) ◽  
pp. 1038-1043 ◽  
Author(s):  
Carsten Hafer ◽  
Jan Kielstein ◽  
Marion Haubitz ◽  
Hermann Haller ◽  
Svjetlana Lovric ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Critically Ill ◽  
Glomerular Basement Membrane ◽  
Critically Ill Patients ◽  
Plasma Levels ◽  
Vascular Inflammation ◽  
Endothelial Damage ◽  
Healthy Controls ◽  
Angiopoietin 2

SummaryIn critically ill patients, the massive release of angiopoietin-2 (Ang-2) from Weibel-Palade bodies interferes with protective angiopoietin-1 (Ang-1)/Tie2 signalling in endothelial cells, thus leading to vascular inflammation and subsequent organ-dysfunction. We hypothesised that plasma exchange (PE) is efficient for lowering excess Ang-2 levels in critically ill patients with thrombocytic microangiopathy (TMA) or anti-glomerular basement membrane (anti-GBM) disease. Plasma Ang-1 and Ang-2 were measured by immuno-luminometric assays in patients with TMA (n=9) or anti-GBM disease (n=4) before and after up to four PE sessions. Twenty apparently healthy volunteers served as controls. Median (IQR) plasma levels of Ang-2 were markedly increased in patients with TMA (7.3 (2.4–21.1) ng/ml) and anti-GBM disease (5.8 (3.4–7.0) ng/ml) compared to healthy controls (1.0 (0.9–1.4) ng/ml, p <0.001). Moreover, Ang-1 plasma levels were decreased in both, TMA (1.02 (0.62–1.62) ng/ml) and anti-GBM disease patients (0.74 (0.59–3.62) ng/ml) compared to healthy controls (2.5 (1.93–3.47) ng/ ml, p <0.005). During a total of 32 treatments, PE effectively lowered elevated mean (SD) Ang-2 plasma levels by 36.7 ± 19.6 % per treatment (p <0.0001), whereas low Ang-1 plasma levels remained unchanged (0.3 ± 58.5 %; p =0.147). Ang-2 levels declined to almost normal values during ≤4 PE treatments (Friedman´s test p <0.0001). PE is an effective method to remove excess circulating Ang-2. It remains to be elucidated if the removal of Ang-2 is crucial to ameliorate endothelial damage in critically ill patients with severely altered endothelial integrity.

scholarly journals MPO-ANCA-Positive Anti-glomerular Basement Membrane Antibody Disease Successfully Treated by Plasma Exchange and Immunosuppressive Therapy

Renal Failure ◽  
2011 ◽  
Vol 33 (6) ◽  
pp. 626-631 ◽  
Author(s):  
Taichi Murakami ◽  
Kojiro Nagai ◽  
Motokazu Matsuura ◽  
Naoki Kondo ◽  
Seiji Kishi ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Immunosuppressive Therapy ◽  
Glomerular Basement Membrane

Plasmapheresis for the Treatment of Acute Pancreatitis due to Severe Hypertriglyceridemia

2020 ◽  
pp. 1-3
Author(s):  
Juan Carlos Ruiz-Rodríguez ◽  
Luis Silvestre Chiscano-Camón ◽  
Clara Palmada ◽  
Verónica Pons ◽  
Ricard Ferrer
Keyword(s):  
Acute Pancreatitis ◽  
Plasma Exchange ◽  
Treatment Options ◽  
Total Plasma ◽  
Severe Hypertriglyceridemia ◽  
Total Plasma Exchange

Severe hypertriglyceridemia (HTG) is associated with acute pancreatitis (AP). Treatment options include total plasma exchange (TPE). We report a case of AP due to severe HTG treated with TPE.

scholarly journals Severe Uncompensated Metabolic Alkalosis due to Plasma Exchange in a Patient with Pulmonary-Renal Syndrome: A Clinician’s Challenge

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Mohsin Ijaz ◽  
Naeem Abbas ◽  
Dmitry Lvovsky
Keyword(s):  
Basement Membrane ◽  
Plasma Exchange ◽  
Glomerular Basement Membrane ◽  
Metabolic Alkalosis ◽  
Fresh Frozen Plasma ◽  
Maintenance Hemodialysis ◽  
Positive Serology ◽  
Aged Woman ◽  
Fresh Frozen ◽  
Intravenous Steroids

Metabolic alkalosis secondary to citrate toxicity from plasma exchange is very uncommon in patients with normal renal function. In patients with advanced renal disease this can be a fatal event. We describe a case of middle-aged woman with Goodpasture’s syndrome treated with plasma exchange who developed severe metabolic alkalosis. High citrate load in plasma exchange fluid is the underlying etiology. Citrate metabolism generates bicarbonate and once its level exceeds the excretory capacity of kidneys, the severe metabolic alkalosis ensues. Our patient presented with generalized weakness, fever, and oliguria and developed rapidly progressive renal failure. Patient had positive serology for antineutrophilic cytoplasmic antibodies myeloperoxidase (ANCA-MPO) and anti-glomerular basement membrane antibodies (anti-GBM). Renal biopsy showed diffuse necrotizing and crescentic glomerulonephritis with linear glomerular basement membrane staining. Patient did not respond to intravenous steroids. Plasma exchange was started with fresh frozen plasma but patient developed severe metabolic alkalosis. This metabolic alkalosis normalized with cessation of plasma exchange and initiation of low bicarbonate hemodialysis. ANCA-MPO and anti-GBM antibodies levels normalized within 2 weeks and remained undetectable at 3 months. Patient still required maintenance hemodialysis.

scholarly journals Acute Aspergillus pneumonia associated with mouldy tree bark-chippings, complicated by anti-glomerular basement membrane disease causing permanent renal failure

2013 ◽  
Vol 2 ◽  
pp. 125-127 ◽  
Author(s):  
Louise Butler ◽  
Tomos Brockley ◽  
David Denning ◽  
Malcolm Richardson ◽  
Roger Chisholm ◽  
...  
Keyword(s):  
Renal Failure ◽  
Basement Membrane ◽  
Glomerular Basement Membrane ◽  
Tree Bark

scholarly journals Total Plasma Exchange in Hypertriglyceridemia-Induced Pancreatitis: Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Harleen Dehal ◽  
Michael Adashek
Keyword(s):  
Plasma Exchange ◽  
Treatment Options ◽  
Clinical Status ◽  
Clinical Situation ◽  
Dramatic Improvement ◽  
Total Plasma ◽  
Rapid Fall ◽  
The Many ◽  
Total Plasma Exchange

Objective. To emphasize the role of apheresis in management of pancreatitis. Methods. The clinical course of a patient admitted for hypertriglyceridemia-induced pancreatitis (HTGP) complicated by multiorgan dysfunction is described, who demonstrated dramatic improvement in his clinical status after total plasma exchange (TPE). In addition, the current guidelines for TPE and the alternative treatment options for HTGP are also presented. Results. A patient presenting with pancreatitis associated with severe systemic inflammatory response was admitted to our hospital with an initial triglyceride level of 1181 mg/dL. Given the patient’s worsening clinical condition, he was started on TPE with a rapid fall in his serum TG levels, in turn leading to early clinical recovery. Conclusion. Though various therapeutic options for the treatment of HTGP are described in literature, there are no set guidelines available to tackle this difficult clinical situation. TPE, albeit not very well known in this context, is one of the many therapies available. Though it leads to a rapid, precipitous fall in the TG levels and early symptom resolution, the data about the long-term morbidity as well as the effectiveness of this therapy is still lacking.

scholarly journals Digestive Pathologies during Chronic Renal Failure in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Mali

2020 ◽  
Vol 10 (01) ◽  
pp. 41-48
Author(s):  
Magara Samaké ◽  
Seydou Sy ◽  
Hamadoun Yattara ◽  
Moctar Coulibaly ◽  
Mamadou Badou Sanogo ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
University Hospital ◽  
Point G ◽  
The University ◽  
Hospital Center
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