title: Significance of small renal artery lesions in patients with antineutrophil cytoplasmic antibody-associated glomerulonephritis.
abstract: OBJECTIVE
  Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis is a vasculitis affecting the glomerular capillaries and small renal arteries. Although crescent formation has been reported to be characteristic of this condition, the significance of coexisting vasculitis affecting the small renal arteries has not been investigated.
  
  
  METHODS
  Fifty patients with ANCA-positive rapidly progressive glomerulonephritis whose renal biopsy specimens contained arterioles and/or interlobular arteries were retrospectively evaluated. Cellular crescents and/or necrotizing glomerulonephritis were noted in all 50 patients. Ten patients had vasculitis of the small renal arteries (group A) and 40 patients were without such vasculitis (group B). The clinical features of these 2 groups were compared.
  
  
  RESULTS
  Group A comprised 4 patients who had granulomatosis with polyangiitis (GPA) and 6 with microscopic polyangiitis (MPA), while group B included 1 patient with GPA and 39 with MPA. No patient in either group had eosinophilic granulomatosis with polyangiitis. The C-reactive protein (CRP) level was significantly higher in group A compared with group B (11.58 ± 6.19 vs 2.7 ± 3.55 mg/dl, p < 0.05), and pulmonary involvement was more frequent in group A than group B (80% vs 37.5%, p < 0.05).
  
  
  CONCLUSIONS
  In patients with ANCA-positive glomerulonephritis, vasculitis of small renal arteries may be associated with systemic vasculitis (including pulmonary involvement) because of elevated CRP, a systemic inflammatory marker related to overproduction of interleukin 6.
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital. kokia5n@yahoo.co.jp ubara@toranomon.gr.jp.
authors.forename: Akiko
authors.initials: A
authors.lastname: Endo
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Junichi
authors.initials: J
authors.lastname: Hoshino
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suwabe
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Koki
authors.initials: K
authors.lastname: Mise
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Rikako
authors.initials: R
authors.lastname: Hiramatsu
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Eiko
authors.initials: E
authors.lastname: Hasegawa
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamanouchi
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hayami
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sawa
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Kenmei
authors.initials: K
authors.lastname: Takaichi
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Ohashi
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujii
authors.affiliation: From the Nephrology Center and Okinaka Memorial Institute for Medical Research, Department of Pathology, and Nephrology Center, Toranomon Hospital; Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.A. Endo, MD, Nephrology Center, Toranomon Hospital, and Division of Nephrology, Department of Internal Medicine, Kyorin University School of Medicine; J. Hoshino, MD; T. Suwabe, MD; K. Sumida, MD; K. Mise, MD; R. Hiramatsu, MD; E. Hasegawa, MD; M. Yamanouchi, MD; N. Hayami, MD; N. Sawa, MD, Nephrology Center, Toranomon Hospital; K. Takaichi, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research; K. Ohashi, MD, Nephrology Center; T. Fujii, MD, Department of Pathology; Y. Ubara, MD, Nephrology Center and Okinaka Memorial Institute for Medical Research, Toranomon Hospital.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Ubara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D001706:Biopsy; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000276:immunology / Q000473:pathology*; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000473:pathology*
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic
keywords: ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; GLOMERULONEPHRITIS; VASCULITIS OF SMALL RENAL ARTERIES