Case summary: A 69 years old male with known CKD and type 2 diabetes mellitus (T2DM) was admitted to hospital following a GP visit. Increased prostate-specific antigen (PSA) levels and raised creatinine levels were observed in his blood tests. Patient was referred from GP due to worsening of creatinine on a background of 2 months of increasing pedal oedema. Ultrasound scan showed no renal obstruction and a renal biopsy confirmed pANCA vasculitis. Urinalysis also confirmed presence of glucose, protein, nitrates and blood in urine. Patient was referred to another hospital for plasma exchange and other treatments.
Background:
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides involves inflammation and necrosis of small blood …show more content…
Granulomatosis with polyangitis (GPA): frequently presents with necrotising granulomatous inflammation of the respiratory tract and frequent occurrence of necrotising glomerulonephritis(3)
2. Microscopic polyangitis (MPA): frequently presents with necrotising glomerulonephritis, pulmonary capillaritis(3)
3. Renal limited vasculitis: occurrence of isolated pauci-immune necrotizing crescenting glomerulonephritis without other systems involved(3)
4. Eosinophilic granulomatosis with polyangitis (EGPA) - also known as Churg-Strauss syndrome: presents with inflammation of respiratory tract and associated with asthma and blood eosinophilia(3) It was observed that over 20% of patients with ANCA-associated vasculitis will develop end stage renal failure over a 5 years period(28) and these patients require life-long dialysis.
Case presentation and …show more content…
Induction therapy for ANCA-associated renal vasculitis involves the use of high dose intravenous Glucocorticoids and Cyclophosphamide, inducing remission of the disease(1,20). However, this method has a high risk of morbidity and mortality due to infection. Yet this is dependent on patient’s age, duration of the treatment and the dosage of steroids given(20). The usual treatment lasts for about three to six months(1). Moreover, if renal failure occurs, plasma exchange is often used in addition to the standard treatment(21). Cyclophosphamide’s metabolite, phosphoramide mustard, interferes with DNA strand by forming crosslinks and thus inhibiting DNA and RNA synthesis and function, leading to cellular apoptosis(22). However, studies have shown that cyclophosphamide usage will lead to some serious side effects: haemorrhagic cystitis, sepsis, leukopenia and increased risk of bladder cancer(20). As a result, Methotrexate has been used to substitute the more toxic Cyclophosphamide, yet studies show that it has a higher relapse rate. Also, excretion of this drug is mostly by the kidneys, and thus it is not routinely
Background:
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides involves inflammation and necrosis of small blood …show more content…
Granulomatosis with polyangitis (GPA): frequently presents with necrotising granulomatous inflammation of the respiratory tract and frequent occurrence of necrotising glomerulonephritis(3)
2. Microscopic polyangitis (MPA): frequently presents with necrotising glomerulonephritis, pulmonary capillaritis(3)
3. Renal limited vasculitis: occurrence of isolated pauci-immune necrotizing crescenting glomerulonephritis without other systems involved(3)
4. Eosinophilic granulomatosis with polyangitis (EGPA) - also known as Churg-Strauss syndrome: presents with inflammation of respiratory tract and associated with asthma and blood eosinophilia(3) It was observed that over 20% of patients with ANCA-associated vasculitis will develop end stage renal failure over a 5 years period(28) and these patients require life-long dialysis.
Case presentation and …show more content…
Induction therapy for ANCA-associated renal vasculitis involves the use of high dose intravenous Glucocorticoids and Cyclophosphamide, inducing remission of the disease(1,20). However, this method has a high risk of morbidity and mortality due to infection. Yet this is dependent on patient’s age, duration of the treatment and the dosage of steroids given(20). The usual treatment lasts for about three to six months(1). Moreover, if renal failure occurs, plasma exchange is often used in addition to the standard treatment(21). Cyclophosphamide’s metabolite, phosphoramide mustard, interferes with DNA strand by forming crosslinks and thus inhibiting DNA and RNA synthesis and function, leading to cellular apoptosis(22). However, studies have shown that cyclophosphamide usage will lead to some serious side effects: haemorrhagic cystitis, sepsis, leukopenia and increased risk of bladder cancer(20). As a result, Methotrexate has been used to substitute the more toxic Cyclophosphamide, yet studies show that it has a higher relapse rate. Also, excretion of this drug is mostly by the kidneys, and thus it is not routinely