PMID- 22921791
OWN - NLM
STAT- MEDLINE
DCOM- 20130801
LR  - 20130218
IS  - 1873-0183 (Electronic)
IS  - 1568-9972 (Linking)
VI  - 12
IP  - 4
DP  - 2013 Feb
TI  - Renal involvement in anti-neutrophil cytoplasmic autoantibody associated 
      vasculitis.
PG  - 477-82
LID - S1568-9972(12)00170-X [pii]
LID - 10.1016/j.autrev.2012.08.006 [doi]
AB  - Renal involvement is a common and often severe complication of anti-neutrophil 
      cytoplasmic autoantibody (ANCA) associated vasculitides (AAV). With the exception 
      of Churg-Strauss syndrome (CSS), where kidney involvement is not a prominent 
      feature, renal disease is present in about 70% of patients with Wegener's 
      granulomatosis, now called granulomatosis with polyangiitis (GPA) and in almost 
      100% of patients with microscopic polyangiitis (MPA). Kidney involvement is 
      generally characterized by a pauci-immune necrotizing and crescentic 
      glomerulonephritis with a very rapid decline of renal function (rapidly 
      progressive glomerulonephritis). Even though there are not qualitative 
      differences in glomerular lesions in patients with GPA or with MPA, chronic 
      damage is significantly higher in MPA (and/or P-ANCA positive patients) than in 
      GPA (and/or C-ANCA positive patients). If untreated necrotizing and crescentic 
      glomerulonephritis has an unfavorable course leading in a few weeks or months to 
      end stage renal disease. Serum creatinine at diagnosis, sclerotic lesions and the 
      number of normal glomeruli at kidney biopsy are the best predictors of renal 
      outcome. Corticosteroids and cyclophosphamide (with the addition of plasma 
      exchange in the most severe cases) are the cornerstone of induction treatment of 
      ANCA-associated renal vasculitis, followed by azathioprine for maintenance. 
      Rituximab is as effective as cyclophosphamide in inducing remission in AAV and 
      probably superior to cyclophosphamide in patients with severe flare, and could be 
      preferred in younger patients in order to preserve fertility and in patients with 
      serious relapses.
CI  - Copyright (c) 2012 Elsevier B.V. All rights reserved.
FAU - Sinico, Renato A
AU  - Sinico RA
AD  - Clinical Immunology Unit and Renal Unit, Department of Medicine, Azienda 
      Ospedaliera Ospedale San Carlo Borromeo, via Pio Secondo, 3, 20153 Milano, Italy. 
      renatoalberto.sinico@fastwebnet.it
FAU - Di Toma, Luca
AU  - Di Toma L
FAU - Radice, Antonella
AU  - Radice A
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20120816
PL  - Netherlands
TA  - Autoimmun Rev
JT  - Autoimmunity reviews
JID - 101128967
SB  - IM
MH  - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/*complications
MH  - Churg-Strauss Syndrome/complications
MH  - Glomerulonephritis/diagnosis/drug therapy/etiology
MH  - Humans
MH  - Kidney Diseases/*diagnosis/drug therapy/*etiology
MH  - Prognosis
EDAT- 2012/08/28 06:00
MHDA- 2013/08/02 06:00
CRDT- 2012/08/28 06:00
PHST- 2012/08/28 06:00 [entrez]
PHST- 2012/08/28 06:00 [pubmed]
PHST- 2013/08/02 06:00 [medline]
AID - S1568-9972(12)00170-X [pii]
AID - 10.1016/j.autrev.2012.08.006 [doi]
PST - ppublish
SO  - Autoimmun Rev. 2013 Feb;12(4):477-82. doi: 10.1016/j.autrev.2012.08.006. Epub 
      2012 Aug 16.