Objective: To investigate the effect of dual plasma exchange on renal function and Birmingham Vasculitis Activity Score (BVAS) in patients with renal damage caused by anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV). Methods: The clinical data of 102 patients with AAV renal damage in Department of Nephrology, Haikou Third People’s Hospital were retrospectively analyzed. Among them, 44 patients were treated with glucocorticoid (GC) combined with cyclophosphamide (CTX) AAV standard regimen, which served as a CTX group; the other 58 patients were treated with CTX regimen and plasma exchange, which served as an observation group. Serum ANCA level, serum creatinine (Scr), blood urea nitrogen (BUN), albumin (ALB), BVAS score, and adverse reactions were compared between the two groups. Results: After treatment, the titers of PR3-ANCA, MPO-ANCA, Scr, BUN, and BVAS in the two groups were significantly decreased (P<0.05). The titers of PR3-ANCA, MPO-ANCA, Scr, and BVAS in the observation group were lower than those in the CTX group (P<0.05), and there was no significant difference in ALB level between the two groups before and after treatment (P>0.05). There was no significant difference in the total incidence of pulmonary infection, gastrointestinal reactions, and adverse reactions between the two groups (P>0.05). Conclusion: Plasma exchange can effectively reduce ANCA titer, improve renal function and reduce BVAS score in patients with AAV renal damage, without reducing ALB level and increasing adverse reactions, and the safety is good.