Vasculitis and the kidney.
This review analyzes the current literature on small vessel vasculitis affecting the kidney, and emphasizes the important contribution of anti-neutrophil cytoplasmic antibodies to recent advances in understanding. There is a very strong correlation between the presence of these auto-antibodies and the types of systemic vasculitis that cause crescentic glomerulonephritis with scanty immune deposits. Despite this, it is not yet clear whether anti-neutrophil cytoplasmic antibodies cause vasculitis or merely reflect its presence. However, the recent demonstration of anti-neutrophil cytoplasmic antibodies in spontaneous murine models of vasculitis, and the development of a model of vasculitis caused by immunity to myeloperoxidase strengthen the case for a pathogenic role. Regardless of whether they are pathogenic, sequential measurement of anti-neutrophil cytoplasmic antibody titres have proved extremely useful in the management of patients with systemic vasculitis. They are a considerable help in diagnosis, but perhaps they are even more important as a guide to maintenance immosuppressive therapy; relapses are rare when anti-neutrophil cytoplasmic antibodies cannot be detected, and are common when their titres are rising. Other ways to minimize exposure to cyclophosphamide are also reviewed.
Rees
A J
AJ
Department of Medicine and Therapeutics, University of Aberdeen, Forresterhill, UK.
D000818:Animals; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis; D015415:Biomarkers; D006801:Humans; D015994:Incidence; D012079:Renal Circulation; D014657:Vasculitis / Q000145:classification / Q000276:immunology / Q000628:therapy
D019268:Antibodies, Antineutrophil Cytoplasmic; D015415:Biomarkers