Title: Plasmapheresis in Diabetic Nephropathy

Biography:

Professor Valerii A. Voinov, MD, PhD, Head of the Department of Apheresis Therapy of the I.P. Pavlov First Saint Petersburg Medical University. He is the author of more than 450 scientific publications (among which more than 20 monographs), 25 patents and authorship certificates. The scope of scientific interest includes treatment of patients with multiple organ failure, allergic and autoimmune diseases in various spheres of medicine such as pulmonology, rheumatology, nephrology, neurology, surgery and critical care, obstetrics, neonatology and many others.

Abstract

Diabetic nephropathy came to one of the first places among the causes of terminal renal failure. Diabetic patients in Europe and the United States are now about half among those undergoing hemodialysis. Direct toxicity of elevated glucose concentrations for the nephron structures with concomitant lipid metabolism disorders (frequent lipid deposition in the kidneys) and subsequent sclerotic changes in mesangium cells, together with deposits of circulating immune complexes underlie renal parenchyma lesions in diabetes.

In recent years, attention has been drawn to the role of “vascular endothelial growth factor” as a multifunctional cytokine, known as vascular permeability factor, in development of micro- and macrovascular complications in diabetes and, in particular, diabetic nephropathy. If immune complex glomerulonephritis is typical for Type 1 diabetes, then atherosclerotic nephroangiosclerosis – for Type 2 diabetes. Due to increase in vascular permeability during nephropathy, the earliest signal for the development of such a pathology is the detection of microalbuminuria (concentration - 30-200 mg / l, or excretion at a rate of 20-200 μg / min), which can be found in 29-41% of diabetics with the disease duration of more than 5-7 years. 70% of diabetics with microalbuminuria suffer from arterial hypertension, which strengthens the link between diabetes and nephropathy.

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.