[Biological and evolutive spectrum of patients ANCA present]. / Aspecte paraclinice si evolutive la pacientii cu ANCA pozitivi.

AIM: To analyse the immuno-biological profile of patients with antineutrophil cytoplasmic antibodies (ANCA) presents. This is a retrospective study of all ANCA positives cases from Nephrology Clinic Iasi during five years (1998-2003) on a cohort of 97 patients. RESULTS: pANCA was positive in 28, cANCA was positive in 60 and the others had pANCA and cANCA. The diseases ANCA associated were: systemic vasculitis, rapidly progressive glomerulonephritis (GNRP), chronic renal failure of an unknown etiology. ANCA presence was associated with inflammatory syndrome in 83.5%, anemic syndrome in 71.1%. From the patients with renal disfunction (71.1%), half of them presented an increased level of creatinine (>6 mg%). Renal biopsy proven especially crescentic glomerulonephritis. The complications and the diseases were more frequent in cANCA cases. CONCLUSIONS: cANCA presence is a negative prognosis factor in vasculitis; testing ANCA alone cannot be used to guide treatment.

[Relation between arterial compliance and the prematurity of reflected wave on pulse pressure curve evaluated by tonometric sphygmography]. / Relatia dintre complianta arteriala si precocitatea undei reflectate la nivelul curbei presiunii pulsului evaluata prin sfigmografia tonometrica.

The effect of antihypertensive drugs on the arterial pressure pulse can usually be explained by a change in the timing or intensity of wave reflection or by alteration in the pattern of ventricular ejection. Alteration in timing wave reflection is believed to cause the characteristic changes of pressure wave such: augmentation, augmentation index, "precocity index of second systolic peek" (P2). After calcium channel blockers augmentation decreases from 15 mmHg to 9.4 mmHg, augmentation index P2/P1 (P1 is the first systolic peek) decreases from 132.2 +/- 20% to 129.2 +/- 19.5% and "precocity index of P2" increases from 68.8 +/- 5% ejection duration to 71.8 +/- 4.6% ejection duration.

[Retrospective study of 97 ANCA-positive patients: epidemiologic and clinical spectrum]. / Analiza retrospectiva a 97 de cazuri cu ANCA pozitivi: aspecte epidemiologice si clinice.

UNLABELLED: We analysed the clinical profile of antineutrophil cytoplasmic antibodies (ANCA) positive patients in a retrospective study including all cases of ANCA positivity (determined by ELISA) from the Nephrology Clinic, Parhon University Hospital Iasi during the interval 1998-2003. There were 97 ANCA positive patients (mean age 43.7 s18-75t years, female/male ratio 1.55), of whom almost two thirds had c-ANCA, almost one third p-ANCA, while 9 patients had both types of antibodies. The incidence was 22.5/pmp for the North-Eastern province of Romania. Just 19.3% from the suspected cases with ANCA-associated disease were positive for these antibodies. 47.7% had systemic vasculitis (10 with microscopic polyangiitis--MA, 6 with Wegener's granulomatosis--WG, 1 with Churg-Strauss angiitis, 29 with non-specific vasculitis--NSV). Twenty-seven (27.8%) had connective tissue disease--CTD (systemic lupus erythematosus, rheumatoid arthritis, polymyositis, systemic sclerosis, mixed connective tissue disease, and sarcoidosis), while in 5 cases ANCA were associated with other diseases. Nine cases presented with rapid progressive glomerulonephritis (RPGN) without signs of systemic involvement, and other ten with advanced chronic renal failure (CRF). The most frequent clinical manifestations involved the kidney (71%), the skin, the muscles and joints, and the cardiovascular system. CONCLUSIONS: ANCA positivity is associated with a wide spectrum of diseases, mostly with CTD and NSV. c-ANCA was predominantly seen in WG and advanced CRF, while p-ANCA was associated with MA. In nonspecific vasculitis and connective tissue diseases, both patterns were present. We recommend ANCA determination as a screening method in all cases with renal dysfunction and nephritic syndrome and/or with signs of systemic vasculitis and/or collagenosis.