Differences between Myeloperoxidase-Specific and -Nonspecific P-ANCA-Associated Renal Disease

Oda, Hiroshi; Wakui, Hideki; Komatsuda, Atsushi; Chyzh, K.A.; Hatakeyama, Takashi; Masai, Rie; Okuyama, Shin; Togashi, Masaru; Sawada, Kenichi

doi:10.1080/08860220601098854

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Clinical assessment of treatments More detailed outcomes were previously described elsewhere in 4 very elderly patients in our series: a patient with massive glomerular deposition of monoclonal IgM-κ [15], a patient with malignancy-associated MN [16], a patient with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis [17], and a patient with proliferative glomerulonephritis with monoclonal IgG deposits [18].…”

Section: Contribution Of Renal Biopsy To Determine Therapeutic Intervmentioning

confidence: 99%

Renal biopsy in patients aged 80 years and older: a single-center experience in Japan

Omokawa¹,

Komatsuda²,

Nara³

et al. 2012

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Background: There is a paucity of data on renal biopsy in a large number of the very elderly (age ≥ 80 years) worldwide. Methods: Clinicopathological features in 73 patients aged ≥ 80 years were evaluated and compared with control groups of 172 patients aged 60 -61 years and 128 patients aged 70 -71 years. Results: The common indications for biopsy in the very elderly were nephrotic syndrome (NS), followed by proteinuria without NS and/or hematuria, and acute kidney injury (AKI). Histological diagnoses were considered to potentially modify treatment in 57 cases (78.1%): the most frequent diagnosis was membranous nephropathy, followed by minimal change disease, and various other diseases. There were no biopsy procedure-related serious complications. Clinical assessment of treatments was evaluated in 38 of 54 patients with AKI and/or NS. Improvement in renal dysfunction or NS was observed in 24 of 30 (80%) patients who received immunosuppressive therapy. There were statistically significant differences in the disease spectrum between the very elderly and control groups. Conclusions: This is the first report of renal biopsy findings in a relatively large number of Japanese very elderly patients. Histological observations are useful aids in estimating the prognosis and therapy selection for renal disorders, even in the very elderly.

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Section: Contribution Of Renal Biopsy To Determine Therapeutic Intervmentioning

confidence: 99%

Renal biopsy in patients aged 80 years and older: a single-center experience in Japan

Omokawa¹,

Komatsuda²,

Nara³

et al. 2012

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“…[12] Studies of hydralazine-induced ANCA-positive glomerulonephritis have underlined the utility of MPO antibodies in the diagnosis of drug-induced vasculitis. [5,[13][14][15] An extensive review of the literature shows only twelve patients with ANCA-positive hydralazine-associated vasculitis with both kidney and lung involvement (see Table 1). The hydralazine dose ranged from 50 to 200 mg per day, and the treatment duration varied from 1 to 14 years.…”

Section: Discussionmentioning

confidence: 99%

Hydralazine-Induced ANCA-Positive Pauci-immune Glomerulonephritis: A Case Report and Literature Review

2009

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We report a case of hydralazine-induced alveolar hemorrhage and anti-neutrophil cytoplasmic antibody (ANCA)-positive pauci-immune glomerulonephritis, with serum anti-histone antibodies present, features not previously described in the literature with this drug. A 50-year-old Caucasian female had hypertension treated with hydralazine 75mg TID for three years, and a lung nodule followed up periodically with chest-computed tomographies. She was admitted to the hospital for hemoptysis and newly discovered diffuse pulmonary ground-glass opacities. Transbronchial lung biopsy showed alveolar hemorrhage. Serum creatinine was 3.5 mg/dL and urinalysis showed 2+blood, 30-50RBC/hpf and red blood cell casts. ANCA against myeloperoxidase were present. Anti-double-stranded DNA, ANA, and anti-histone antibodies were positive. Serum complements were normal. Renal biopsy revealed focal crescentic necrotizing glomerulonephritis with negative immunofluorescence, consistent with pauci-immune ANCA-positive vasculitis. Serum creatinine returned to baseline three days after hydralazine was discontinued, and the hemoptysis resolved after treatment with cyclophosphamide and prednisone was started. We concluded that this case represents a hydralazine-induced small vessel vasculitis rather than an idiopathic one. The possibility of hydralazine-induced vasculitis should be considered when patients treated with hydralazine develop a pulmonary-renal syndrome. Anti-histone antibodies may be present in the absence of full classification criteria of drug-induced lupus.

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“…1 Perinuclear ANCA (p-ANCA) vasculitis classically targets myeloperoxidase and is associated with higher rates of renal complications compared with cytoplasmic ANCA (c-ANCA) vasculitis. 2 Over 90% of granulomatosis with polyangiitis is associated with c-ANCA, while 90% of microscopic polyangiitis (MPA) and 40% of eosinophilic granulomatosis with polyangiitis are associated with p-ANCA. 3 Ophthalmologic signs of AAV have been reported in 30% to 50% of patients with granulomatosis with polyangiitis but less than 10% of patients with eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis.…”

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P-ANCA Vasculitis Presenting with Orbital Infiltration

Yoo,

Abella-Ayala,

Lerner

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) may affect the eye or orbit, and ophthalmic manifestations of AAV are associated with higher mortality than other inflammatory eye diseases. Perinuclear ANCA (p-ANCA) vasculitis is an uncommon cause of orbital inflammation. A 70-year-old woman with chronic kidney disease presented with a 1-year history of orbital mass and edema around her OD. Fundoscopy revealed 360° optic disc elevation OD. MRI orbits showed an infiltrative, intra- and extraconal lesion extending through the right orbital apex to the cavernous sinus. Labwork and orbital biopsy were consistent with p-ANCA vasculitis, and the patient’s ocular symptoms improved after methylprednisolone. Diagnosis of AAV is complicated by a wide diversity of symptoms, and this case highlights an unusual presentation of p-ANCA vasculitis in the orbit. Ophthalmologists have an important role in diagnosing systemic conditions such as AAV by initiating the proper inflammatory workup.

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Differences between Myeloperoxidase-Specific and -Nonspecific P-ANCA-Associated Renal Disease

Cited by 5 publications

References 16 publications

Renal biopsy in patients aged 80 years and older: a single-center experience in Japan

Renal biopsy in patients aged 80 years and older: a single-center experience in Japan

Hydralazine-Induced ANCA-Positive Pauci-immune Glomerulonephritis: A Case Report and Literature Review

P-ANCA Vasculitis Presenting with Orbital Infiltration

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