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Plasmapheresis for Treatment of Kidney Diseases | Kidney Transplant
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Need a plasmapheresis for the treatment of kidney diseases? NU Hospitals provide highly effective treatment for the
whole spectrum of kidney and bladder diseases.
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                        <h2>OVERVIEW</h2>
                        <p>Plasmapheresis is a specialized procedure that is performed in the ICU for certain patients
                            who are very sick with some specific kidney diseases. In this procedure, large quantities of
                            plasma are removed from a patient and replaced with fresh frozen plasma, albumin or saline.
                            A vascular access in the form of an internal jugular catheter/femoral vein catheter/AV
                            fistula/AV graft is required. A plasma filter is used for the procedure. Haemodialysis
                            machines with the blood pump and bloodlines are used. Replacement fluid is infused into the
                            bloodline. Anticoagulation is used appropriately.</p>



                        <p>Some of the conditions requiring plasmapheresis are an anti-GBM disease, Hemolytic Uraemic
                            Syndrome/Thrombotic Thrombocytopenic Purpura, Cryoglobulinemia, some vasculitic processes,
                            recurrent FSGS in renal transplant, sensitized patients waiting for renal transplant.</p>
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                                                    Renal biopsy- A Neuropathologist’s perspective:
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                                                    <p>Renal Biopsy, a relatively safe medical procedure, has gained considerable importance for the diagnosis of medical renal diseases. Nowadays, a spring-loaded automated cutting needle, with or without ultrasound guidance, is used for obtaining renal tissue core. The lower pole of the native left kidney and most visible or accessible pole of the transplanted kidney is utilized for renal Biopsy. In adults, 14-or 16-gauge needles are suitable, considering the internal diameter of 900-1000 micron and 600-700 micron, respectively (average diameter of the normal glomerulus in an adult is 200-250 micron). The finer needle of 18-gauge (internal diameter 300-400 micron) may be used for children younger than 8 years.</p>

<p>Whenever possible, 2-3 cores of renal Biopsy should be taken: one for light microscopy (LM), another for immunofluorescence (IF) and one for electron microscopy (EM), if required. These renal Biopsy cores should be sent in separate vials containing appropriate fixative/transport media for each of these tests (Light microscopy- 10% Formalin, Immunofluorescence- Michel’s transport medium or normal saline, Electron microscopy- 2.5% Glutaraldehyde). The biopsies sent in normal saline should be processed within 6 hours. In cases where taking extra passes is not possible, a cutting protocol may be followed: both the ends of the core are taken for EM, one-third of the core, including some glomeruli, is placed in the transport medium for IF and the rest is kept for LM.</p>

<p>The Neuropathologist always works closely with nephrologists and transplant surgeons, who typically obtain diagnostic specimens via percutaneous renal Biopsy. The absence of adequate pertinent clinical information seriously hinders any meaningful evaluation of renal Biopsy. Ideally, the renal Biopsy should be accompanied by pertinent clinical information. Detailed clinical history, including past medical illnesses; recent laboratory values with particular emphasis on urinalysis, biochemical parameters (urea, creatinine, total protein, cholesterol), serological investigations (ANA, dsDNA, ANCA, C3, C4, anti-GBM), viral markers (hepatitis B, hepatitis C, HIV) and other parameters of interest should be included. Details of any therapy administered should also be mentioned. In cases of renal transplant biopsies, information must include the duration of transplant and therapy. Neuropathologist, knowledgeable in both renal medicine and pathology, can correlate subtle tissue-derived information with appropriate clinical data. This remains the most important key to the development of an accurate clinicopathologic diagnosis. It needs to be remembered that renal pathology cannot succeed as a standalone practice. Extremely close collaboration and teamwork between a Nephrologist and Neuropathologist is the key to achieving the appropriate management of patients</p>
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                                                    Adequacy of biopsy
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                                                    <p>The minimum diagnostic sample size varies with the specific diagnosis; for instance, only one glomerulus is enough for making diagnoses such as Membranous Glomerulonephritis and Amyloidosis, while 25 glomeruli may be required to make an accurate diagnosis of a focal lesion like FSGS. For most of the light microscopic assessment, 8-10 glomeruli are considered adequate.</p>


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                                                    Nephropathology at NU Hospitals
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                                                    <p>Nephropathology Department was started at NU Hospitals in February 2015. A comprehensive evaluation of renal biopsies will be done by a qualified Neuropathologist. The biopsies can be sent either in colour-coded vials provided by the NU Hospitals or in separate vials containing appropriate fixative/transport media for each of these tests (Light microscopy- 10% Formalin, Immunofluorescence- Michel’s transport medium or normal saline, Electron microscopy- 2.5% Glutaraldehyde). Sample sent in normal saline should be accompanied with an ice pack in case the transportation takes more than 6 hours. Courier service can be utilized for the transport of samples from the outstation. The reports will be dispatched via mail with pictures.</p>
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                                                    Chronic Renal Failure:
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                                                        <p>Is irreversible kidney failure. The causes for Chronic Renal Failure are Diabetes Mellitus (the most common cause), hypertension, long-term usage of painkillers, certain genetic diseases, recurrent urinary tract infections (especially in children), and certain other primary kidney diseases</p>
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