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ABO-mismatched renal transplantation
Allogenic renal transplantation

ABO-mismatched renal transplantation is often accompanied by irreversible hyperacute rejection. In the 1980s, it was confirmed that with plasmapheresis the grafted kidney can adapt without causing hyperacute rejection, allowing ABO-mismatched kidney donation for transplantation. Currently, double filtration plasmapheresis (DFPP) or plasma exchange (PE) is generally performed before and after renal transplantation to lower antibody titers by removing anti-A or anti-B antibodies.

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Rapidly progressive glomerulonephritis (RPGN)

Rapidly progressive glomerulonephritis (RPGN) is a nephritic syndrome with poor prognosis resulting in rapid loss of renal function over weeks to months. Early symptoms include fatigue, fever, anorexia, upper respiratory tract inflammation, and arthralgia. Steroids and immunosuppressants are the primary treatment. However, when DFPP or PE is performed in combination with medication for conditions with poor prognosis, including anti-basement membrane antibody-induced disease or antineutrophil cytoplasmic antibody-positive (ANCA)-RPGN, significant improvements in prognosis are seen.

Henoch-Schönlein purpura nephritis

Henoch-Schönlein purpura nephritis is a syndrome of allergic angiitis in microvessels in the skin, joints, digestive tract, and kidneys, mainly occurring in infants. Suspected causes include bacterial/viral infection and anaphylaxis. There is no established medical treatment, but steroids and immunosuppressants are administered. DFPP or PE is also performed alone or in combination with medication.

Systemic lupus erythematosus (SLE)

Systemic lupus erythematosus (SLE) is a systemic chronic inflammatory disease thought to be caused by an autoimmune reaction. Dysfunction of the immune system injures cells and tissues, causing inflammation in various parts of the body including the skin and joints. The wide range of SLE symptoms include epilation, cerebrovascular disorders, pneumonia, myocarditis, polyarthritis, renal injury, and peripheral neuropathy. The possible etiology of the disease is related to the anti-double-strand DNA antibody and immune complex. Plasmapheresis to remove these factors is an established treatment for SLE.

Arteriosclerosis obliterans (ASO)

Arteriosclerosis obliterans (ASO) is a pathologic chronic blood flow disturbance caused by arteriosclerosis in the aorta abdominalis and lower limb arteries. As the blood pools in the lower limbs, the patient experiences coldness and numbness in the toes, with dysbasia. If untreated, patients with ASO can develop necrosis of the toes and in extreme cases must undergo amputation of the lower limb. Other complications of ASO include ischemic heart disease (e.g., angina pectoris and myocardial infarction) and cerebrovascular events (e.g., stroke).
The treatment is medical therapy or surgical intervention, depending on symptom progression. When medication does not lead to sufficient improvement and surgical options are difficult to perform, DFPP is used to remove factors causing arteriosclerosis (e.g., LDL cholesterol).

Focal glomerulosclerosis

In focal glomerulosclerosis, focal sclerosing lesions occur in the renal glomeruli. Many patients exhibit symptoms referred to as "nephrotic syndrome," characterized by progressive loss of renal function and poor prognosis. In the nephrotic syndrome, generalized massive edema and albuminuria are observed in addition to hypoproteinemia and hyperlipidemia, including cholesterolemia.
Pharmacotherapy is administered to focal glomerulosclerosis patients. In case it is not effective, DFPP is performed to remove LDL cholesterol and causative factors such as IgM and complement.

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Acute renal failure

Renal failure is a state of impaired renal function with various etiologies. Waste and fluid that are normally excreted accumulate in the blood, and uremic symptoms occur with progression.
Acute renal failure is a sudden loss of renal function, triggered by renal disease or other factors. Waste products, such as urea and creatinine, rapidly accumulate in the blood. Continuous renal replacement therapy (CRRT) is performed to remove excess waste and fluid in parallel with treatment of the underlying disease.