Plasma exchange in the treatment of rapidly progressive glomerulonephritis.

Plasma exchange has been used for the treatment of rapidly progressive glomerulonephritis (RPGN) for more than 40 years. Its main application has been the rapid removal of special pathogenic factors that are of great importance for treatment of antiglomerular basement membrane disease, antineutrophil cytoplasmic antibody-associated vasculitis, and immune complex-mediated crescentic nephritis. Although the number of controlled trials is increasing, evidence for the benefit of plasma exchange in RPGN has varied in quality and the results are controversial. Moreover, its efficacy appears to depend on the type and duration of crescentic nephritis. Patients with pulmonary hemorrhage need plasma exchange to alleviate their symptoms and improve their chance of survival. Further trials are needed to ascertain the optimal dose, frequency and number of plasma exchange sessions, long-term outcomes, as well as the role of plasma exchange in the treatment of RPGN.