To the Editor: Guillain-Barre syndrome (GBS) is an acute inflammatory disease affecting myelin and axons of the peripheral nervous system. A breakdown of tolerance to autoantigens of the peripheral nervous system is considered the cause of Guillain-Barre syndrome.Citation[[1]] Subtypes of Guillain-Barre syndrome defined by preceding infections have been only approximately associated with different patterns of clinical, neurophysiologic, and immunologic features.Citation[[2]] Most patients have no identified infection. Patients with Guillain-Barre syndrome often receive plasma exchange (PE) or double-filtration plasmapheresis (DFPP).Citation[[3]] We previously reported that DFPP is effective for renal injuries in patients with proliferative lupus nephritis.Citation[[4]] In a recent report, Tagawa et al.Citation[[3]] observed that the use of PE, which removes anti-ganglioside IgG antibodies better than DFPP does, resulted in a greater decrease in IgG concentration than that accomplished with the use of DFPP. They theorized that PE would be better than DFPP as the first choice treatment for plasmapheresis in Guillain-Barre syndrome patients. In contrast, Chen et al.Citation[[5]] reported that DFPP might be as effective as PE in the treatment of Guillain-Barre syndrome. Little is known, however, about the effect of PE or DFPP in chronic glomerulonephritis (CGN) patients with Guillain-Barre syndrome.
In the present study, we compared the effects of two treatments in these patients. Ten CGN patients with Guillain-Barre syndrome (IgA nephropathy in 6 and unknown origin in 4) were randomly assigned to one of two treatment groups: PE group (3 men and 2 women, aged 20–65 years) and DFPP group (3 men and 2 women, aged 30–70 years). None of the patients had cardiac disease, collagen disease, liver disease, diabetes mellitus, or other neurological disorders. Patients with renal dysfunction (serum creatinine >1.5 mg/dL or 24-h creatinine clearance <80 mL/min) were excluded. Patients suffering from acute ascending motor weakness and fulfilling the diagnostic criteria for Guillain-Barre syndrome were chosen for plasmapheresis. Each patient received at least 5 sessions of apheresis over 14 days, approximately 2.5–3.0 L of plasma was processed in each session. Patients were evaluated by disability grade according to the Hughes scale. The mean grade of disability was 3.60 at the start and had improved to 2.30 at 4 weeks after the start of PE treatment. In DFPP treatment, the mean grade of disability was 3.80 at the start and had improved to 2.40 at 4 weeks after the start of the treatment. The median time to reach grade 2 (walk without support) was 18 days in the PE group and 20 days in the DFPP group. All patients were discharged within 40 days (mean: PE group, 33 days; DFPP group, 35 days).
Our present data suggest that DFPP is as effective as PE in the treatment of Guillain-Barre syndrome in patients with chronic glomerulonephritis.
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