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Rev Prat ; 58(5): 499-506, 2008 Mar 15.
Article in French | MEDLINE | ID: mdl-18524106

ABSTRACT

Renal involvement occurs in 75% of the patients with systemic necrotizing small-vessel vasculitis ie microscopic polyangiitis, Wegener's granulomatosis or Churg-Strauss syndrome. Small-vessel vasculitis may also be limited to the kidney. The hallmark of small-vessel pauci-immune vasculitides consists of necrotizing glomerulonephritis and resultant crescent formation, without immune-complex deposits in vessel walls. The resulting renal manifestations consist of haematuria, proteinuria and rapidly progressive renal failure. ANCA testing has a 90% sensitivity for renal-associated pauci-immune small-vessel vasculitis. Kidney biopsy is required for demonstrating necrotizing vasculitis. Early identification and prompt treatment are mandatory to avoid early mortality and end-stage renal failure. Induction therapy combines corticosteroids and IV cyclophosphamide. Plasma exchange in indicated in the patients presenting with active renal lesions and serum creatinine > 500 micromol/L. Maintenance of immunosuppressive therapy is required for 18 months. Twenty to 50% of the patients relapse during follow-up, and close monitoring is warranted for early detection.


Subject(s)
Churg-Strauss Syndrome/diagnosis , Glomerulonephritis/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Kidney/pathology , Vasculitis/diagnosis , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Biopsy , Churg-Strauss Syndrome/pathology , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Follow-Up Studies , Glomerulonephritis/etiology , Glomerulonephritis/pathology , Granulomatosis with Polyangiitis/pathology , Hematuria/diagnosis , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Multicenter Studies as Topic , Plasma Exchange , Prognosis , Proteinuria/diagnosis , Recurrence , Renal Insufficiency/etiology , Renal Insufficiency/pathology , Renal Insufficiency/therapy , Time Factors , Vasculitis/pathology
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