Interest of a Kidney Biopsy to Rule out ANCA-Associated Renal Vasculitis in Glomerulonephritis Patients with a Positive ANCA

Case Reports in Nephrology and Dialysis

Hélène Perrochia¹  Laurent Daniel²  Pedram Ahmadpoor³  Cédric Aglae³  Olivier Moranne³  Florian Garo³ 

[1] Department of Pathology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France;Department of Pathology, la Timone University Hospital, APHM, Marseille, France;Nephrology-Dialysis-Apheresis Unit, Nimes University Hospital, Nimes, France;

关键词: anca-associated vasculitis;    kidney biopsy;    glomerulonephritis;    arteriosclerosis;    diabetes;   

DOI  :  10.1159/000521862

来源: DOAJ

【 摘 要 】

Kidney biopsy is the gold standard for diagnosing glomerular kidney disease. Some authors debate the necessity of systematically performing kidney biopsies in ANCA-associated vasculitis (AAV) to confirm the diagnosis and assess the severity of renal damage. Nevertheless, kidney involvement is considered an organ-threatening disease requiring an aggressive immunosuppressive regimen. We present a series of 4 cases with a high clinical suspicion of ANCA-associated crescentic glomerulonephritis based on rising serum creatinine, presence of proteinuria and/or hematuria, and presence of ANCA with specificity against PR-3 or MPO. The main diagnosis, however, was arterionephrosclerosis without renal AAV. Certain comorbidities, such as diabetes and/or high blood pressure, can quickly mimic progressive glomerulonephritis. In addition, some patients with AAV do not have high creatinine, proteinuria, or hematuria levels. ANCA alone is not specific to AAV and has a poor positive predictive value. The main concern is to prevent the unnecessary, inappropriate complications of heavy immunosuppression, i.e., serious infections or risk of future malignancies. Kidney pathological confirmation is important in patients with no compatible extra-renal manifestations of AAV or any other possible renal diagnosis such as may be found in polyvascular disease or diabetic patients.

【 授权许可】

Unknown