ANCA-associated glomerulonephritis
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Etiology
Epidemiology
- accounts for > 1/2 of rapidly progressive glomerulonephritis in elderly
Pathology
Clinical manifestations
- prodrome of malaise, arthralgia, myalgia, flu-like symptoms
- variable, from hematuria to rapidly progressive glomerulonephritis[1]
- variable, from pulmonary infiltrate to hemoptysis[1]
- epistaxis
- acute renal failure
- lacy or reticular rash characteristic of leukocytoclastic vasculitis (palpable purpura)[1]
Laboratory
- urinalysis
- dark brown urine, hematuria, proteinuria
- renal function tests
- neutrophil cytoplasmic antibody (ANCA) in serum
- serum complement levels are normal
Diagnostic procedures
- renal biopsy with immunofluorescence staining
- pauci-immune staining (ANCA-associated glomerulonephritis)
- linear staining (anti-glomerular basement membrane disease)
- granular staining (lupus nephritis)
Management
- plasmapheresis QD for 2 weeks for ANCA-associated glomerulonephritis associated with pulmonary hemorrhage[1]
- combination of glucocorticoids + cyclophosphamide or rituximab[1]
- indicated for pulmonary alveolar disease[1]
- reduces progression to ESRD at 1 year, but not 1 year mortality
- mortality benefit for immunosuppression begins to emerge after 1 year[2]
More general terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Medical Knowledge Self Assessment Program (MKSAP) 18, 19 American College of Physicians, Philadelphia 2018, 2021
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 2.0 2.1 Bomback AS, Appel GB, Radhakrishnan J et al ANCA-associated glomerulonephritis in the very elderly. Kidney Int. 2011 Apr;79(7):757-64. Epub 2010 Dec 15. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21160463 Free Article