BACKGROUND Therapeutic plasma exchange (TPE) is used in kidney diseases as an adjunct treatment. Little has been described as to its effectiveness in kidney disorders in children. This study aimed to assess the safety, efficacy, and outcomes of patients who underwent TPE for kidney indications. METHODS Retrospective chart review of patients receiving TPE from 2010 to 2018 for kidney indications, such as antibody-mediated rejection, bone marrow transplant-associated thrombotic microangiopathy (TA-TMA), atypical hemolytic uremic syndrome, transplant recurrence of focal segmental glomerulosclerosis, and glomerulonephritis. Outcomes assessed were trends in kidney function, mortality, and progression to stage 5 chronic kidney disease (CKD 5). Significant hypocalcemia was defined as ionized calcium < 1 mmol/L. RESULTS A total of 641 TPE procedures were performed on 47 patients (25 male). Average age was 12.8 ± 5.9 years. Median glomerular filtration rate (GFR) improved from baseline to end of TPE treatments (pre 44.9 (19.8, 79), end 56.1 (23, 98) [p = 0.02]). Ten out of 47 children developed CKD 5. Seven out of 47 patients died; 5 had TA-TMA. Initial 7 consecutive sessions were reviewed for complications. Among 335 procedures, 41 episodes of significant hypocalcemia were noted (12.2%); only 1 was symptomatic. Of the 26 episodes (7.7%) of allergic reactions, all were associated with the use of FFP; 5 were anaphylactic. No TPE-associated mortality was noted. CONCLUSIONS TPE is a relatively well-tolerated useful adjunct therapy in children with kidney indications. The benefit of TPE has to be balanced with risks such as hypocalcemia and allergic reactions which can occur more frequently with FFP. Graphical abstract.

中文翻译：

---

治疗性血浆置换：肾脏疾病儿童的单中心经验。

背景治疗性血浆置换（TPE）在肾脏疾病中用作辅助治疗。关于其对儿童肾脏疾病的有效性的描述很少。本研究旨在评估因肾脏适应症而接受 TPE 的患者的安全性、有效性和结果。方法 对 2010 年至 2018 年因肾脏适应症接受 TPE 的患者进行回顾性图表审查，例如抗体介导的排斥反应、骨髓移植相关血栓性微血管病 (TA-TMA)、非典型溶血性尿毒症综合征、局灶节段性肾小球硬化的移植复发和肾小球肾炎. 评估的结果是肾功能、死亡率和进展到第 5 期慢性肾病 (CKD 5) 的趋势。显着低钙血症定义为离子钙 < 1 mmol/L。结果 总共对 47 名患者（25 名男性）进行了 641 次 TPE 手术。平均年龄为 12.8 ± 5.9 岁。从基线到 TPE 治疗结束，中位肾小球滤过率 (GFR) 有所改善（前 44.9 (19.8, 79)，结束 56.1 (23, 98) [p = 0.02]）。47 名儿童中有 10 名发展为 CKD 5。47 名患者中有 7 名死亡；5 人有 TA-TMA。最初连续 7 次治疗的并发症进行了审查。在 335 次手术中，有 41 次出现明显的低钙血症 (12.2%)；只有1个有症状。在 26 次 (7.7%) 的过敏反应中，都与使用 FFP 相关；5人过敏。没有注意到与 TPE 相关的死亡率。结论 TPE 是一种耐受性相对较好的有用辅助疗法，适用于有肾脏适应症的儿童。TPE 的益处必须与低钙血症和过敏反应等风险相平衡，这些风险在 FFP 中可能发生得更频繁。图形概要。