Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

Ren Fail. 2023 Dec;45(1):2176694. doi: 10.1080/0886022X.2023.2176694.


Purpose: This study aimed to assess efficacy of extracorporeal plasma therapy (EPT), including plasmapheresis (PE), immunoadsorption (IA), low-density lipoprotein apheresis (LDL-A), and lymphocytapheresis (LCAP) for adult native kidney patients with primary focal segmental glomerulosclerosis (FSGS).

Methods: A literature search was conducted using MEDLINE, EMBASE and Cochrane Databases through August 2022. Studies that reported outcomes of EPT in adult native kidneys with primary FSGS were enrolled.

Results: 18 studies with 104 therapy-resistant or refractory primary native FSGS patients were identified. Overall EPT response rate was 56%, with long-term benefit of 46%. Of the 101 non-hemodialysis (HD) patients, 54% achieved remission, with 30% complete remission (CR) and 23% partial remission (PR). Of 31 patients with PE, response rate was 65%; CR and PR rates were 27% and 37% in 30 non-HD patients. Of 61 patients with LDL-A, the response rate was 54%; CR and PR rates were 41% and 3% in 29 non-HD patients. Of 10 patients with IA, response rate was 40%. Of 2 patients with LCAP, 1 achieved CR, and one developed renal failure. All 3 HD patients showed increase in urine output and gradual decrease in urine protein excretion following PE (n = 1) or LDL-A (n = 2). 2 of 3 HD patients ultimately discontinued dialysis.

Conclusion: EPT with immunosuppressive therapy showed benefit in some patients with refractory primary FSGS, and PE appeared to have a higher response rate.

Keywords: Extracorporeal plasma therapy; FSGS; focal segmental glomerulosclerosis; plasmapheresis.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Glomerulosclerosis, Focal Segmental* / therapy
  • Humans
  • Kidney
  • Kidney Transplantation*
  • Proteinuria
  • Recurrence
  • Treatment Outcome

Grants and funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.