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L. Pitfalls of diagnosis of ANCA-associated vasculitis – case report


Authors: M. A. Sokalska-Jurkiewicz 1;  M. Kment 2;  R. Ryšavá 3;  L. Šedová 1
Authors place of work: Revmatologický ústav Praha 1;  Institut klinické a experimentální medicíny, Praha 2;  Klinika nefrologie 1. LF UK a VFN, Praha 3
Published in the journal: Čes. Revmatol., 28, 2020, No. 4, p. 248-252.
Category: Case Report

Summary

ANCA-associated vasculitides (AAV) are a group of rare, autoinflammatory diseases with the presence of serum autoantibodies against neutrophil cytoplasm. Inflammation of the small vessels (polyangiitis) with granulomas and tissue necrosis represents the underlying mechanism of the disease. Renal involvement is one of the most severe clinical manifestations of AAV and often presents with rapidly progressive glomerulonephritis (RPGN). We describe a case of a patient suffering from granulomatosis with polyangiitis with renal involvement, whose first renal biopsy was negative. Despite that, the patient was intensely treated with glucocorticoids, cyclophosphamide, and azathioprine. Due to the progression of renal symptoms, a second biopsy was performed, and active glomerulonephritis was confirmed. Based on the described case, we would like to highlight that despite the negative results of the first kidney biopsy, the patient suffered from a severe and progressive form of the disease with renal involvement that required rituximab treatment to reach remission.

Keywords:

ANCA – ANCA associated vasculitis – glomerulonephritis – renal biopsy – rituximab


Zdroje

1. Tsalouchos A, Salvadori M. Epidemiology and pathogenesis of ANCA-associated vasculitis. In: Zahoorullah S. Reviews in Imunology. In-Press SM Group Open Access eBooks 2018; 1–24.

2. Nakazawa D, Masuda S, Tomaru U, Ishizu A. Pathogenesis and therapeutic interventions for ANCA-associated vasculitis. Nat Rev Rheumatol 2019; 15: 91–101.

3. Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med 1977; 337: 1512–1523.

4. Zakyianov O, Vachek J, Tesař V. Rychle progredující glomerulonefritidy (srpkovité glomerulonefritidy). Kardiol Rev Int Med 2014; 16(1): 62–66.

5. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 1992; 116(6): 488–498.

6. Rowaiye OO, Kusztal M, Klinger M. The kidneys and ANCA-associated vasculitis: from pathogenesis to diagnosis. Clin Kidney J 2015; 8(3): 343–350.

7. Jayne DRW, Bruchfeld AN, Harper L, Schaier M, Venning MC, Hamilton P, et al. Randomized Trial of C5a Receptor Inhibitor Avacopan in ANCA-Associated Vasculitis. JASN 2017; 28 (9): 2756–2767.

8. Kubaisi B, Samra KA, Foster CS. Granulomatosis with polyangiitis (Wegener’s disease): An updated review of ocular disease manifestations. Intractable Rare Dis Res 2016; 5(2): 61–69.

9. Godman CC, Churg J. Wegener’s granulomatosis: Pathology and review of the literature. AMA Arch Pathol 1954; 58: 533–553.

10. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, et al. The American College of Rheumatology 1990 criteria for the classification of Wegener‘s granulomatosis. Arthritis Rheum 1990; 33: 1101–1107.

11. Robson J, Grayson P, Ponte C, Suppiah R, Craven A, Khalid S, et al. OP0021 Draft classification criteria for the anca associated vasculitides. Ann Rheum Dis 2018; 77: 60–61.

12. Berden AE, Ferrario F, Christiaan Hagen E, Jayne DR, Jennette JC, Joh K, et al. Histopathologic Classification of ANCA-Associated Glomerulonephritis. JASN 2010; 21: 1628–1636.

13. Aasarød K, Bostad L, Hammerstrøm J, Jørstad S, Iversen BM. Renal histopathology and clinical course in 94 patients with Wegener’s granulomatosis. Nephrology Dialysis Transplantation 2001; 16(5): 953–960.

Štítky
Dermatology & STDs Paediatric rheumatology Rheumatology

Článok vyšiel v časopise

Czech Rheumatology

Číslo 4

2020 Číslo 4
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