Kidney Involvement in Vasculitis

Kidney Involvement in Vasculitis

2019 Phoenix Patient Conference: Kidney Involvement in Vasculitis
Alicia Rodriguez-Pla, MD, PhD, Arthritis Center, University of Tucson
Tucson, Arizona

Introduction: the function of the kidneys and what happens when they don’t work. 00:28
The structure of the kidneys: nephrons, glomerulus, tubule, renal artery. 02:08
Vasculitis according to vessel size: large, medium, and small 03:59
Vasculitis affecting the kidney: immune complex small vessel vasculitis, medium vessel vasculitis, large vessel vasculitis, and ANCA-associated small vessel vasculitis. 04:47
How does ANCA vasculitis affect the kidneys? Cross section of the kidneys: nephron, glomerulus, tubule. 05:31
Image: Normal glomerulus vs ANCA glomerulonephritis (inflammation). 06:35
Explanation of blood in urine (red or tea-colored), foamy urine, and decreased kidney function. 08:54
Blood tests (when kidney function is reduced, creatinine level rises in blood); urine tests (presence of blood and protein in urine is abnormal). 10:21
Immunology: ANCA, anti-PR3 and anti-MPO-ANCA; kidney ultrasound: to check kidneys are normal size and shape; kidney biopsy: distinctive pattern of inflammation under the microscope. 12:13
Images: segmental fibrinoid necrosis in glomeruli (small cellular crescent) and segmental fibrinoid necrosis in interlobular artery. 14:26
Treatment (3-6 months): induction phase to rapidly reduce inflammation and prevent permanent organ damage, high-dose steroids + cyclophosphamide and/or rituximab; plasma exchange. 15:31
Treatment (18 months): maintenance phase/relapse prevention phase once remission has been achieved; taper course of steroids, and either azathioprine or intermittent rituximab infusions. 16:55
Renal relapses: what’s usually seen, fluctuations in the amount of protein in the urine, how relapses are treated. 17:40
End stage renal disease and dialysis. 18:44
Predictors of end stage renal disease. 20:54
Renal transplantation: 70% or transplants are still working after 10 years plus other statistics. 22:47
Important take-home messages. 23:50