Plasma Exchange for Anti‐ GBM Disease With Dialysis Dependency: A Case Series on Clinical Outcomes and Safety

Introduction The efficacy of plasma exchange (PEx) in patients with anti‐glomerular basement membrane antibody (anti‐GBM Ab) disease requiring renal replacement therapy (RRT) at diagnosis remains unclear. This study aimed to investigate the outcomes and safety of patients with uremic anti‐GBM Ab disease undergoing PEx. Methods We retrospectively analyzed nine patients confirmed by renal biopsy who received PEx using fresh frozen plasma or 5% human albumin solution and underwent hemodialysis (HD) concomitantly with standard immunosuppressive therapy. The outcome was determined as dialysis dependency, and safety was evaluated for adverse events. Results Two patients (22.2%) achieved dialysis independence at 10 and 11 months. Both patients had relatively preserved normal glomeruli (15.8%–37.2%) and achieved early remission. Retroperitoneal hemorrhage and recalcitrant anti‐GBM Ab were noteworthy in other cases. Conclusion PEx can facilitate renal recovery in selected patients with anti‐GBM disease requiring RRT. Pathological evaluation may be useful to determine the intensity and duration of treatment, including PEx.