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The clinical presentation and treatment of renal vasculitis 

The clinical presentation and treatment of renal vasculitis
The clinical presentation and treatment of renal vasculitis

David Jayne

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date: 01 October 2020

1. Vasculitis is an avoidable cause of ESRD, and ESRD is usually the result of a delayed diagnosis.

2. ANCA-associated renal vasculitis is a common cause of unexplained acute renal failure in the elderly.

3. A prodromal phase of flu-like symptoms, weight loss and polymyalgia usually precedes a diagnosis of ANCA vasculitis by several months.

4. There should be a high index of suspicion for vasculitis in the presence of persisting unexplained constitutional symptoms or focal signs of inflammation, such as, arthritis, episcleritis or chronic ENT disease.

5. Active renal vasculitis is always accompanied by haematuria and proteinuria. Their absence reliably excludes this diagnosis.

6. Rituximab is an alternative induction therapy to cyclophosphamide, especially when treating relapsing or refractory disease.

7. Plasma exchange increases rates of renal recovery in severe presentations and is also used for alveolar haemorrhage.

8. Following successful remission induction, prolonged remission maintenance therapy is required to prevent relapse. Azathioprine is more effective than mycophenolate mofetil and preferable to methotrexate when there is renal impairment.

9. ANCA testing has a role in predicting relapse risk and a positive ANCA is more closely associated with relapse after treatment withdrawal.

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