ANCA-Associated Glomerulonephritis and Anti-Phospholipid Syndrome in a Patient with SARS-CoV-2 Infection: Just a Coincidence?

Many reports have described a high incidence of acute kidney injury (AKI) among patients with COVID-19. Acute tubular necrosis has been reported to be the most common damage in these patients, probably due to hemodynamic instability. However, other complex processes may be involved, related to the cytokine storm and the activation of innate and adaptive immunity. Here, we describe a patient who developed an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with rapidly progressive glomerulonephritis and lung involvement and an antiphospholipid syndrome soon after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After viral pneumonia was excluded by bronchoalveolar lavage, the patient has been treated with rituximab for amelioration of kidney function and resolution of thrombosis without any adverse event. We conclude that COVID-19 may trigger autoimmune diseases including ANCA-associated vasculitis. Thus, this diagnosis should be taken in consideration in COVID-19 patients, especially when they develop AKI with active urinary sediment. In addition, considering the relationship between these 2 diseases, SARS-CoV-2 infection should be excluded in all patients with a new diagnosis ANCA-associated vasculitis before starting immunosuppressive therapy.

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Acute Kidney Injury due to Anticoagulant-Related Nephropathy : A Suggestion for Therapy

Case Reports in Nephrology ◽

10.1155/2020/8952670 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Letizia Zeni ◽

Chiara Manenti ◽

Simona Fisogni ◽

Vincenzo Terlizzi ◽

Federica Verzeletti ◽

...

Keyword(s):

Acute Kidney Injury ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Kidney Injury ◽

Cast Nephropathy ◽

Anca Associated Vasculitis ◽

A Prospective Study ◽

The Relationship ◽

Gross Haematuria ◽

Strong Suspicion

The relationship between kidneys and anticoagulation is complex, especially after introduction of the direct oral anticoagulants (DOAC). It is recently growing evidence of an anticoagulant-related nephropathy (ARN), a form of acute kidney injury caused by excessive anticoagulation. The pathogenesis of kidney damage in this setting is multifactorial, and nowadays, there is no established treatment. We describe a case of ARN, admitted to our Nephrology Unit with a strong suspicion of ANCA-associated vasculitis due to gross haematuria and haemoptysis; the patient was being given dabigatran. Renal biopsy excluded ANCA-associated vasculitis and diagnosed a red blood cell cast nephropathy superimposed to an underlying IgA nephropathy. Several mechanisms are possibly responsible for kidney injury in ARN: tubular obstruction, cytotoxicity of heme-containing molecules and free iron, and activation of proinflammatory/proﬁbrotic cytokines. Therefore, the patient was given a multilevel strategy of treatment. A combination of reversal of coagulopathy (i.e., withdrawal of dabigatran and infusion of its specific antidote) along with administration of fluids, sodium bicarbonate, steroids, and mannitol resulted in conservative management of AKI and fast recovery of renal function. This observation could suggest a prospective study aiming to find the best therapy of ARN.

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A systematic review of the relationship between acute tubular necrosis and kidney transplantation

Journal of Renal Injury Prevention ◽

10.34172/jrip.2021.18 ◽

2020 ◽

Vol 10 (3) ◽

pp. e18-e18

Author(s):

Arezo Elmi ◽

Mohammad Arabsorkhi Mishabi ◽

Esmaeil Teymoori ◽

Dorrin Nikbakht ◽

Nazanin Sarraf ◽

...

Keyword(s):

Systematic Review ◽

Kidney Transplantation ◽

Acute Tubular Necrosis ◽

Web Of Science ◽

Kidney Injury ◽

Tubular Necrosis ◽

Deceased Donors ◽

English Articles ◽

Predicting Factor ◽

The Relationship

Introduction: Acute tubular necrosis (ATN) is a common syndrome following kidney transplantation. In this study, we reviewed systematically the relationship between ATN and kidney transplantation. Materials and Methods: International databases including PubMed, Web of Science and Scopus were considered for search of English articles by Aug 2019. Seven published articles were finally entered into the study. Keywords were ATN, acute kidney injury, kidney transplantation and renal transplantation or a combination of them in the title/abstracts. Results: There were seven published articles (conducted on 2,534 individuals) reviewed in this systematic review consisted of two retrospective, three prospective studies and two clinical trial studies. Conclusion: The administration of cyclosporine immediately following kidney transplantation is a predicting factor for development of ATN. According to the results, ATN can be associated with kidney transplantation, especially transplanted from deceased donors.

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Acute tubulointerstitial nephritis associated with antineutrophil cytoplasmic antibody following cimetidine treatment: a case report

BMC Nephrology ◽

10.1186/s12882-021-02502-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Keita Morimoto ◽

Go Kanzaki ◽

Takahito Niikura ◽

Kentaro Koike ◽

Nanae Matsuo ◽

...

Keyword(s):

Tubulointerstitial Nephritis ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Antineutrophil Cytoplasmic Antibody ◽

Oral Steroid ◽

Lymphocyte Stimulation Test ◽

Drug Induced ◽

Acute Tubulointerstitial Nephritis ◽

Cimetidine Treatment ◽

Glomerular Lesions

Abstract Background Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis usually induces rapidly progressive glomerulonephritis, including pauci-immune necrotizing crescentic glomerulonephritis. Acute tubulointerstitial nephritis (ATIN), which is often drug-induced, is a frequent cause of kidney injury. However, ATIN associated with ANCA without any glomerular lesions has been rarely reported, and drug-induced ATIN associated with ANCA is not well recognized. Here we present a case of an older woman with ATIN associated with myeloperoxidase-ANCA (MPO-ANCA) following cimetidine treatment. Case presentation A 70-year-old woman was admitted to our hospital due to acute kidney injury and mild proteinuria. She had a one-year history of chronic thyroiditis and dyslipidemia, for which she was taking levothyroxine sodium and atorvastatin, respectively. Two weeks before admission she had started cimetidine, methylmethionine sulfonium chloride, and itopride hydrochloride for gastric discomfort persistent since a month. She had experienced fatigue for two weeks and later appetite loss. The patient demonstrated a positive titer for MPO-ANCA (192 IU/mL) and a positive drug-induced lymphocyte stimulation test for cimetidine. She underwent two kidney biopsies that revealed ATIN without any glomerular lesions. Despite discontinuation of cimetidine on admission, renal injury continued with the presence of high MPO-ANCA titer. Oral steroid treatment was closely related with the recovery of her renal function and disappearance of MPO-ANCA. Conclusions In this case, ATIN presented as sustained renal insufficiency and high MPO-ANCA titer despite withdrawal of cimetidine. Therefore, we reason that the development of ANCA-associated ATIN was caused by cimetidine. Serologic follow-up with measurement of MPO-ANCA titers and renal biopsy are recommended when the clinical history is inconsistent with the relatively benign course of drug-induced ATIN.

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Rapidly progressive glomerulonephritis in children

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.38.icon-2022.5774 ◽

2021 ◽

Vol 38 (ICON-2022) ◽

Author(s):

Khemchand N Moorani ◽

Madiha Aziz ◽

Farhana Amanullah

Keyword(s):

Immune Complex ◽

Search Strategy ◽

Rapid Development ◽

Clinical Manifestations ◽

Specific Treatment ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Antineutrophil Cytoplasmic Antibody ◽

Good Prognosis ◽

Cochrane Library

Rapidly progressive glomerulonephritis (RPGN), characterized by a rapid development of nephritis with loss of kidney function in days or weeks, is typically associated histologically, with crescents in most glomeruli; and is a challenging problem, particularly in low resource settings. RPGN is a diagnostic and therapeutic emergency requiring prompt evaluation and treatment to prevent poor outcomes. Histopathologically, RPGN consists of four major categories, anti-glomerular basement membrane (GBM) disease, immune complex mediated, pauci-immune disorders and idiopathic /overlap disorders. Clinical manifestations include gross hematuria, proteinuria, oliguria, hypertension and edema. Diagnostic evaluation, including renal function tests, electrolytes, urinalysis/microscopy and serology including (anti GBM antibody, antineutrophil cytoplasmic antibody (ANCA)) starts simultaneously with management. An urgent renal biopsy is required to allow specific pathologic diagnosis as well as to assess disease activity and chronicity to guide specific treatment. The current guidelines for management of pediatric RPGN are adopted from adult experience and consist of induction and maintenance therapy. Aggressive combination immunosuppression has markedly improved outcomes, however, nephrotic syndrome, severe acute kidney injury requiring dialysis, presence of fibrous crescents and chronicity are predictors of poor renal survival. RPGN associated post infectious glomerulonephritis (PIGN) usually has good prognosis in children without immunosuppression whereas immune-complex-mediated GN and lupus nephritis (LN) are associated with poor prognosis with development of end stage kidney disease (ESKD) in more than 50% and 30% respectively. Given the need for prompt diagnosis and urgent treatment to avoid devastating outcomes, we conducted a review of the latest evidence in RPGN management to help formulate clinical practice guidance for children in our setting.Information sources and search strategy: The search strategy was performed in the digital databases of PubMed, Cochrane Library, google scholar, from their inception dates to December 2020. Three investigators independently performed a systematic search using the following search terms “Rapidly progressive glomerulonephritis” “children” “crescentic glomerulonephritis” “management” at the same time, backtracking search for references of related literature. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5774 How to cite this:Moorani KN, Aziz M, Amanullah F. Rapidly progressive glomerulonephritis in children. Pak J Med Sci. 2022;38(2):417-425. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5774 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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ANCA associated glomerulonephritis in tuberculosis: a paradoxical reaction

BMJ Case Reports ◽

10.1136/bcr-2021-241904 ◽

2021 ◽

Vol 14 (6) ◽

pp. e241904

Author(s):

Shane OBrien ◽

Brenda Griffin ◽

Anne Marie McLaughlin ◽

Joseph Keane

Keyword(s):

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Antineutrophil Cytoplasmic Antibodies ◽

Antituberculous Therapy ◽

Tb Treatment ◽

Anca Associated Vasculitis ◽

First Case ◽

Paradoxical Worsening ◽

Perinuclear Anca ◽

Hiv Negative

We present a case of antineutrophil cytoplasmic antibodies (ANCA)-associated rapidly progressive glomerulonephritis in the context of treatment of pulmonary tuberculosis (TB). A 42-year-old woman was treated for drug-susceptible pulmonary TB and represented with paradoxical worsening of symptoms and radiological features. She was HIV negative. A severe acute kidney injury with features of glomerulonephritis was evident on admission. Perinuclear ANCA and antimyeloperoxidase antibodies were present in serum and renal biopsy was consistent with ANCA-associated vasculitis. The patient was successfully treated with both antituberculous therapy and immunosuppression (corticosteroids and mycophenolate mofetil) with subsequent clinical improvement and amelioration of renal function. We propose this is the first case that describes the association between paradoxical reactions during TB treatment and ANCA-associated glomerulonephritis.

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Treatment strategy ANCA-associated renal vasculitides in children and adolescents

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2019-23-5-107-115 ◽

2019 ◽

Vol 23 (5) ◽

pp. 107-115

Author(s):

N. D. Savenkova

Keyword(s):

Children And Adolescents ◽

Rapidly Progressive Glomerulonephritis ◽

Supportive Therapy ◽

Antineutrophil Cytoplasmic Antibody ◽

Kidney Damage ◽

Adult Patients ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Treatment Protocols ◽

Anca Associated Vasculitis ◽

Therapy Strategy

The article presents the terminology and classification in accordance with the International Сhapel Hill Сonsensus Сonference nomenclature of vasculitides (2012), clinical, immunological and morphological manifestations, therapy strategy and outcome of Antineutrophil cytoplasmic antibody vasculitides (ANCA) renal associated vasculitis (microscopic polyanghiitis, granulomatosis with Wegener's polyangiitis, eosinophilic granulomatosis with polyangiitis Churg-Strauss) in children and adolescents. IgG class antibodies to MPO and PR3, histopathological changes in renal biopsy specimens are considered the gold standard in the diagnosis of ANCA-glomerulonephritis. Following the recommendations of The European Vasculitis Study Group (EUVAS) in adult patients, ANCA-associated vasculitis describes the categories of disease severity: localized, early systemic, severe, generalized, refractory. An algorithm for the treatment of ANCA-associated vasculitis, recommended by EULAR (2009) for adult patients and adapted for children of L.A. Plumb et al (2018), which provides for a differentiated approach to the induction of remission in localized, early systemic, severe, generalized, refractory categories of severity and supportive therapy in localized, early systemic, generalized categories, second-line therapy. In most cases of ANCA-associated renal vasculitis in children and adolescents, it is kidney damage that manifests rapidly progressive glomerulonephritis with acute kidney damage, determines the severity and prognosis of outcome in terminal uremia. It seems important and necessary in the treatment protocols of ANCA-associated vasculitis to include a strategy for pre-dialysis and dialysis of rapidly progressive glomerulonephritis with acute kidney damage in children and adolescents.

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ANCAassociated vasculitis in a man with scleroderma and pulmonary fibrosis

Canadian Journal of General Internal Medicine ◽

10.22374/cjgim.v13i3.164 ◽

2018 ◽

Vol 13 (3) ◽

pp. 21-24

Author(s):

Alyson Wong ◽

Christine McDonald ◽

John Thenganatt

Keyword(s):

Acute Kidney Injury ◽

Pulmonary Hypertension ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Kidney Injury ◽

Internal Organs ◽

Anca Associated Vasculitis ◽

Pulmonary Manifestations ◽

Pulmonary Arterial ◽

New Diagnosis

Systemic sclerosis, or scleroderma, is a connective tissue disease that causes fibrosis of the skin and potentially internal organs (1). The most common lung findings in those with scleroderma are interstitial lung disease and pulmonary hypertension (1). Here we describe a 58-year-old man with scleroderma, interstitial lung disease and pulmonary arterial hypertension. He presented with atypical pulmonary manifestations and an acute kidney injury caused by a new diagnosis of ANCA-associated vasculitis.

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MO395EPIDEMIOLOGY AND OUTCOME OF PATIENTS WITH ACUTE KIDNEY INJURY REQUIRING DIALYSIS: ABOUT 230 CASES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0049 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Yosra Elouaer ◽

Yosra Guedri ◽

Mohamed Riadh Troudi ◽

Awatef Azzabi ◽

Sanda Mrabet ◽

...

Keyword(s):

Renal Failure ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Cross Sectional Study ◽

Dialysis Session ◽

University Hospitals ◽

Cross Sectional ◽

Tubular Necrosis ◽

Risk Of Progression ◽

Evolutionary Step

Abstract Background and Aims Acute renal injury (ARI) is a frequent pathology. Rarer are the studies dedicated specifically to the subgroup requiring dialysis. The objective of our study is to identify: The epidemiological profiles of patients with ARI requiring dialysis. The course of the dialysis sessions to determine the dialysis’ prescription and the different accidents. Method This is a descriptive cross-sectional study including patients admitted to the different departments of Sousse University Hospitals in Tunisia who presented an ARI requiring emergency dialysis. Our study was conducted from February 2015 until August 2018. The data collected were analysed by the SPSS software. Results During three and a half years, 230 patients presented ARI requiring dialysis. The average age was 60 ± 16 years old. The sex ratio was 1.61. A history of hypertension, diabetes, heart disease, dyslipidaemia, hyperuricemia, uropathy and neoplasia was noted in respectively 34.9%, 27.1%, 21.6%, 22.7%, 25.5%, 22.7% and 14.3% cases. The causes of ARI were dominated by organic, obstructive and functional causes in 66.2%, 21.7% and 7.4% of cases, respectively. For organic causes, we noted acute tubular necrosis in 70.4% of cases, a glomerular cause in 14.5% of cases, an interstitial cause in 7.9% of cases and a vascular cause in 7.2% of cases. Dialysis indications were dominated by severe acidosis, pulmonary oedema, uremic syndrome and hyperkalaemia in 27.4%, 24.3%, 16.5% and 14.3% of cases, respectively. Among our patients, 26.7% presented a hemodynamic instability with catecholamine use in 16.8% of cases and the use of isovolumic connection at the beginning of the session in 21.2% of cases. The median ultrafiltration was 444 ml / hour IQR [166, 67-750] with extremes of 0 to 1333 ml/hour. The median blood flow was 250 ml/min IQR [250-280] with extremes of 180 to 300 ml/min. The median duration of dialysis’ session was 180 minutes IQR [180,240] with extremes of 15 to 360 minutes. We noted dialysis incidents in 12% of dialysis’ sessions. These events were dominated by hypotension, hypoglycaemia, extracorporeal circuit coagulation, death and chest pain in 13.8%, 4.8%, 2.6%, 2.1% and 0.7% of cases, respectively. The cessation of dialysis sessions was noted in 22 sessions (11.1%). Concerning the evolution of patients: 33.1% of patients recovered normal renal function, 23.9% of patients maintained renal failure, 22.2% of patients died and 20.8% of patients were lost from seen or the duration of their follow-up was less than three months not making it possible to conclude as to the chronicity of the renal insufficiency. Conclusion ARI is a common and serious pathology. Dialysis is an important evolutionary step. It is associated with a high risk of progression to chronic renal failure and mortality. Optimal management of ARI is required.

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Urinary cytology as a tool for differential diagnosis between acute tubular necrosis and proliferative glomerulonephritis in patients with nephrotic syndrome and acute kidney injury

10.21203/rs.3.rs-42639/v1 ◽

2020 ◽

Author(s):

Caroline Vilas Boas de Melo ◽

Maria Brandão Tavares ◽

Paula Neves Fernandes ◽

Carlos Alberto Santos Silva ◽

Ricardo David Couto ◽

...

Keyword(s):

Acute Kidney Injury ◽

Differential Diagnosis ◽

Nephrotic Syndrome ◽

Acute Tubular Necrosis ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Small Cells ◽

Urinary Cytology ◽

Glomerular Lesion ◽

Tubular Necrosis

Abstract Objective Acute tubular necrosis (ATN) is a frequent cause of acute kidney injury (AKI). In patients with nephrotic syndrome (NS), AKI demands the differential diagnosis between ATN and rapidly progressive glomerulonephritis. In some cases, conclusive diagnosis is possible only by kidney biopsy. We aimed to study the potential use of urine cytology in the differential diagnosis between ATN and proliferative glomerular lesion in patients with NS.Results Cell size analysis showed a higher proportion of small cells and a lower proportion of large cells in the urine of patients with AKI. Cells phenotypes were easily defined using cytological preparations. Leukocytes were found to be a primary classifier of NS groups, with higher number in patients with AKI and patients with proliferative glomerular lesions. Our data suggests that urinary cytology can be readily performed and support the differential diagnosis between proliferative glomerular lesion and ATN in patients with NS and AKI.

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Weighted Gene Correlation Network Analysis Applied to Identify the Immune Cell-related Hub Genes in ANCA Nephritis

10.21203/rs.3.rs-1246772/v1 ◽

2022 ◽

Author(s):

Juan Jin ◽

Di Zhang ◽

Mingzhu Liang ◽

Wenfang He ◽

Jinshi Zhang

Keyword(s):

Network Analysis ◽

Molecular Mechanisms ◽

Bioinformatics Analysis ◽

Immune Cell ◽

Critical Role ◽

Rapidly Progressive Glomerulonephritis ◽

Antineutrophil Cytoplasmic Antibody ◽

Hub Genes ◽

Anca Associated Vasculitis ◽

Gene Correlation

Abstract Background: Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is the most common reason caused rapidly progressive glomerulonephritis worldwide. But the molecular mechanisms of ANCA - associated nephritis (AAN) have not been thoroughly expounded. So that，we aim to seek the potential molecular pathogenesis of AAN by bioinformatic.Result: Finally, four hub genes, PBK, CEP55, CCNB1 and BUB1B, were identified. These four hub geneswas verified higher in AAN than normal.Conclusion: Those four genes identified by integrated bioinformatics analysis may play a critical role in AAN. May offering a new insights and potential therapeutic to the AAN

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