Nephrol Dial Transplant Vol. 19 No. 12 © ERA-EDTA 2004; all rights reserved
Brief Report
Acute glomerulonephritis occurring during immunoadsorption with staphylococcal protein A column (Prosorba®)
1 The Department of Medicine, Division of Nephrology, Jersey Shore University Medical Center, The Robert Wood Johnson School of Medicine U.M.D.N.J., Neptune, NJ, 2 The Department of Pathology Columbia University, College of Physicians and Surgeons, New York, NY and 3 The Department of Medicine, Division of Nephrology, University of Illinois at Chicago, Chicago, IL, USA
Correspondence and offprint requests to: Jose Iglesias DO, 1617 Route 88 West Brick, NJ 08724, USA. Email: jiglesias{at}verizon.net
Background. Apheresis of patient plasma by immunoadsorption with a staphylococcal protein A (SPA) column is used in a variety of autoimmune disorders. Leukocytoclastic vasculitis is an uncommon severe complication that can occur during immunoadsorption with SPA (Prosorba®).
Methods. We report a case of immune complex glomerulonephritis occurring during Prosorba® immunoabsorption in a patient with rheumatoid arthritis (RA). Using a Medline literature search and information provided by Cypress Bioscience/Fresenius Hemocare, we review renal complications associated with Prosorba® immunoadsorption.
Results. We identified seven additional potential cases of glomerulonephritis (GN) in association with Prosorba® immunoadsorption. Five of these patients were being treated for RA, and two for idiopathic thrombocytopenia purpura (ITP). Renal biopsies were performed on four patients, all of whom had evidence of immune complex GN. Among RA patients treated with Prosorba®, the incidence of GN closely paralleled that of leukocytoclastic vasculitis at 1.75%. The presence of leukocytoclastic vasculitis was a significant risk factor for the development of GN (relative risk = 75.95, CI 7–1869, P = 0.00021). In contrast, among more than 10 000 ITP patients treated with Prosorba®, there were only two potential cases of GN. The risk of developing GN in association with Prosorba® immunoadsorption was significantly greater for patients with RA than for those with ITP (relative risk = 62.95, CI 10–453, P = 0.00002).
Conclusion. This case series highlights the risk of GN among patients undergoing SPA immunoadsorption. The development of GN is associated with the presence of leukocytoclastic vasculitis. Patients with RA seem to be at particular risk.
Keywords: glomerulonephritis; immunoadsorption; leukocytoclastic vasculitis; Prosorba; staphylococcal protein A immunoadsorption