In addition to caring for patients with chronic kidney disease, Fresenius Medical Care provides related specialist expertise in therapeutic apheresis as well as the products required for this treatment. The main focus here is on desensitisation programmes for solid organ transplantation and the treatment of autoimmune diseases.
Acute or chronic antibody-mediated rejection frequently leads to organ loss. This is caused by antibodies directed against structures in the blood capillaries of the transplanted organ. Where such rejection reactions do not respond to drugs, they can be rapidly and effectively interrupted by immunoadsorption.1 Transplant recipients with pre-existing human leukocyte antigen (HLA) or ABO antibodies show an increased risk of transplant rejection. Preventive removal of antibodies against histocompatibility or blood group antigens using immunoadsorption is a proven established modality.2,3,4,5 The combination of immunoadsorption and MONET® Lipoprotein filtration is proven to be effective in removing both IgG-ABO and IgM-ABO antibodies.6,7
Nephritis is an inflammation of the kidneys that can involve different kidney structures. Nephritis is categorised into several different pathological patterns, which are broadly grouped into non-proliferative or proliferative types. Diagnosing the pattern of nephritis is important because the outcome and treatment differs according to type. The primary causes of nephritis are intrinsic to the kidney. Secondary causes are associated with certain infections (bacterial, viral or parasitic pathogens), drugs, systemic disorders (lupus, vasculitis) or diabetes. Clinically, nephritis affects kidney function and, in some cases, could lead to acute renal failure. Given the link between some nephritides and IgG-associated antibodies, immunoadsorption with GLOBBAFIN or Immunosorba® can offer an additional option beyond standard therapy.8
Membranous nephropathy (MN) is amongst the most common causes of nephrotic syndrome in adults worldwide. Primary or idiopathic MN is considered an autoimmune disease, in which IgG antibodies target PLA2R receptors at the glomerulus basal membrane. While the majority of patients with MN remain stable and experience either complete remission or partial remission, approximately 20% slowly progress to end-stage renal disease. Since the common immunosuppressive treatment regime has side effects, immunoadsorption with GLOBBAFIN or Immunosorba® may offer an additional option when it comes to removing IgG related antibodies. This theory is the subject of a current clinical investigation.9
The following indications are also to be considered for therapeutic apheresis treatments: