Plasmapheresis

Kidney

Immunosuppression

Biopsy

Pulmonary hemorrhage

Renal biopsy

Immunology

Glomerulonephritis

Internal medicine

Medicine

Gastroenterology

Renal function

Antibody

Rapidly progressive glomerulonephritis

Lung

Goodpasture's syndrome

Therapeutic Apheresis and Dialysis

Goodpasture's syndrome is characterized by pulmonary hemorrhage, rapid progressive glomerulonephritis and the presence of anti‐glomerular basement membrane (anti‐GBM) antibodies. Here, we report a case of Goodpasture's syndrome that we treated with double filtration plasmapheresis (DFPP) combined with immunosuppression therapy. The patient was a 32‐year‐old man with the main complaints of low‐grade fever, general fatigue and dyspnea. The clinical diagnosis was renal‐pulmonary syndrome based on pulmonary hemorrhage on chest X‐ray, rapid progressive renal insufficiency, and elevated C‐reactive protein (CRP). Goodpasture's syndrome was diagnosed because the patient was negative for MPO‐ANCA and PR3‐ANCA, and positive for anti‐GBM antibodies. Renal biopsy showed crescentic glomerulonephritis. Hemodialysis, immunosuppression therapy (methylprednisolone and cyclophosphamide) and DFPP were performed. Anti‐GBM antibodies were followed pre‐ and post‐DFPP, and removal efficiency, cost performance and complications were evaluated. The antibody levels were 121 and 84 EU/mL before and after the first DFPP procedure, respectively, giving a removal efficiency of 24%. Subsequently, the removal efficiencies were 52%, 55% and 60% after the second, third and fourth DFPP procedures. For comparison, the immunoglobulin G (IgG) removal efficiencies were 53%, 57%, 60% and 55% after the four respective DFPP procedures; therefore, the removal efficiencies were similar for anti‐GBM antibodies and IgG in all except the first DFPP procedure. The serum anti‐GBM antibody and IgG concentrations decreased from pre‐ to post‐DFPP, indicating that DFPP may be an effective therapeutic approach in Goodpasture's syndrome.

A Case Report of Efficiency of Double Filtration Plasmapheresis in Treatment of Goodpasture's Syndrome