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Nefroloji Pratiğinde Plazmaferez Etkinliğinin Değerlendirilmesi: Tek Merkez Deneyimi

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Evaluation of Efficacy of Plasmapheresis in Nephrology Practice: A Single Center Experience

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Sayfa Aralığı:: 
202-205

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Abstract (Original Language): 
Plazmaferez immünkompleksler, proteine bağlı toksinler, otoantikorlar, kriyoglobulinler, miyeloma hafif zincir, endotoksinler gibi yüksek molekül ağırlıklı solütlerin plazmadan ekstrakorporeal kan temizleme teknikleri ile uzaklaştırılması yöntemidir. Plazmaferez genellikle destek tedavisi olarak kullanılmakla beraber birçok nefrolojik, nörolojik ve hematolojik hastalıkta primer tedavi seçeneği haline gelmiştir. Nefroloji pratiğinde sıklıkla renal transplantasyon, anti GBM hastalığı ve hızlı ilerleyen glomerülonefrit gibi hastalıklarda kullanılmaktadır. Çalışmamızda GATA Nefroloji Bilim Dalı tarafından son 10 yılda (2000-2010) plazmaferez tedavisi uygulanan hastaların retrospektif olarak incelenmesi ve plazmaferez etkinliğinin değerlendirilmesi amaçlanmıştır. Çalışmaya plazmaferez tedavisi uygulanan 28 hasta alındı. Hastaların 9’u (%32,15) posttransplant rejeksiyon, 7’si (%25,00) kresentik glomerülonefrit, 6’sı (%21,43) antiglomeruler bazal membran hastalığı, 2’si (%7,14) multipl miyelom, 2’si (%7,14) hemolitik üremik sendrom ve 1’er (%3,57) vaka fokal segmental glomerüloskleroz ve membranoproliferatif glomerülonefrit tanısı ile takip edilmekteydi. Hastalara toplam 265 seans plazmaferez tedavisi uygulandı. Plazmaferez uyguladığımız hastalarda hastalıkların patogenezinde rol oynayan immünkomplekslerin, immünglobulinlerin ve makromoleküllerin uzaklaştırılması ile tedaviden yarar gördüklerini, daha iyi prognoz sağlandığını ve mortalitenin azaldığını saptadık. Sonuç olarak plazmaferez nefroloji pratiğinde immünsüpresif tedavi ile yanıt alınamayan vakalarda başvurulan seçkin ve etkili bir tedavi seçeneğidir
Abstract (2. Language): 
Plasmapheresis is a method of cleaning the high molecular weight solutes such as immune complexes, protein-bound toxins, autoantibodies, cryoglobulins, myeloma light chains, and endotoxins from the extracorporeal blood plasma with removal techniques. Generally supportive therapy with plasmapheresis has been used as a primary treatment option in many nephrological, neurological, and hematologic diseases. In nephrology practice, it is used for disorders such as renal transplantation, anti-GBM disease and rapidly progressive glomerulonephritis. In our study, patients treated with plasmapheresis at the GATA Nephrology Department in the last 10 years (2000-2010) were retrospectively analysed to evaluate the efficacy of plasmapheresis. 28 patients treated with plasmapheresis were enrolled in the study. Of the patients; 9 (32.15%) were postransplant rejection, 7 (25.00%) crescentic glomerulonephritis, 6 (21.43%) antiglomerular basement membrane disease, 2 (7.14%), multiple myeloma, 2 (7.14%) hemolytic uremic syndrome, 1 (3.57%) focal segmental glomerulosclerosis and 1 (3.57%) case of membranoprolipherative glomerulonephritis. Patients were treated with a total of 265 plasmapheresis sessions. We found that patients treated with plasmapheresis benefited from treatment with the removal of macromolecules such as immuncomplexes and immunoglobulins; better prognosis and decreased mortality were achieved. In conclusion, plasmapheresis is an effective and reasonable treatment option in Nephrology practice for cases that do not respond to standard immunosuppressive therapy.

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DOI 10.5262/tndt.2010.1003.09

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