肾脏病学与肾脏疾病杂志

Plasmapheresis in diabetic nephropathy prevention and treatment

Voinov V.A. and Voinova Ya.V

Diabetic nephropathy is a serious complication of diabetes up to development of terminal renal failure with a high mortality rate. It is important to realize that in its pathogenesis there is accumulation of various pro-inflammatory cytokines, chemokines, adhesion molecules, uric acid and glycated hemoglobin, as well as oxidative stress with increased activity of the renin-angiotensin-aldosterone system. In this case there is thickening of the glomerular basement membrane, mesangial expansion, nodular glomerular sclerosis, and tubulointerstitial fibrosis. Treatment is mainly based on the control of sugar levels and blood pressure and there is practically no validated therapy that can stop the kidney damage progression. Therefore, in all these cases, plasmapheresis is almost the only and pathogenetically justified method of treating and preventing this condition. Only plasmapheresis can remove numerous damaging factors, such as circulating immune complexes (CIC), glycoproteins, lipids, uric acid, endothelin, antibodies to insulin and others. Methods and Results: A normal level of glycaemia can be maintained, but this does not prevent the accumulation of secondary toxic metabolites that damage the walls of the blood vessels, and there are no medications to prevent the progressive course of these complications. Most of these pathological large-molecular substances, such as circulating immune complexes, glycoproteins, lipids, endothelin, antibodies to insulin and others are not excreted by the kidneys and can only be removed using plasmapheresis, which is essentially the only way to correct these complications - elimination of secondary metabolic disorders. And you need to start this not waiting for the terminal renal failure development, but already at the first signs of the kidney damage. Membrane plasmapheresis on the Russian Hemofenix device with a small volume of filling allows it to be performed even on an outpatient basis, including in children, and that expands the possibilities of its use in almost any medical institution, even of the municipal level. This is especially important, given the huge number of patients in need of this treatment.