title: Should immunosuppressives be stopped in granulomatosis with polyangiitis (Wegener's granulomatosis) patients undergoing dialysis?
abstract: Immunosuppressives are frequently stopped in patients with granulomatosis with polyangiitis (GPA) (Wegener's granulomatosis) who develop end-stage renal disease. This is done because of the high frequency of infections reported among dialysis patients under immunosuppressives and the former impression that GPA patients no longer experience relapses after the development of end-stage renal disease. We present here a 22-year-old male patient with GPA who had gastrointestinal, genitourinary and respiratory system involvement. The patient died because of a gastrointestinal disease activation that occurred after immunosuppressives were stopped at the initiation of dialysis. The decision to stop immunosuppressives while starting dialysis should be made on an individual basis in patients with GPA, and the risks and benefits should be carefully evaluated.
authors.affiliation: Department of Internal Medicine, Cerrahpasa Medical School, University of Istanbul, Turkey. derambuyuktas@yahoo.com
authors.forename: Deram
authors.initials: D
authors.lastname: Büyüktas
authors.forename: Gülen
authors.initials: G
authors.lastname: Hatemi
authors.forename: Koray
authors.initials: K
authors.lastname: Tascilar
authors.forename: Izzet
authors.initials: I
authors.lastname: Fresko
authors.forename: Sebahattin
authors.initials: S
authors.lastname: Yurdakul
mesh_terms: D003113:Colonoscopy; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy*; D008297:Male; D012008:Recurrence; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents