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 |
