Renal vasculitis may develop in patients suffering from vasculitis affecting smaller vessels, as is the case in ANCA-associated vasculitides (ANCA means antineutrophil cytoplasmic antibody) [1] [2]. Wegener granulomatosis, microscopic polyangiitis (MPA), and Churg-Strauss syndrome (also known as eosinophilic granulomatosis with polyangiitis) are described as potential causes of renal vasculitis. The clinical presentation of these diseases, although varying in terms of non-renal manifestations, have similar features regarding the kidneys. Hematuria and proteinuria, as well as the presence of white blood cells, casts, and crystals in urine sediment are typical findings [2]. Acute kidney injury (AKI), defined as a rapid decrease in kidney function causing azotemia and electrolyte disbalance, is frequently encountered in patients who develop rapidly progressive glomerulonephritis (RPGN), which is a typical lesion seen in more severe renal injury due to autoimmune mechanisms. In most severe cases, end-stage renal disease (ESRD) due to RPGN may occur in a very short time span, especially in absence of a prompt and accurate diagnosis [2]. Despite the fact that large and medium-sized vessels vasculitic syndromes (such as Takayasu and Kawasaki arteritis, polyarteritis nodosa, and giant cell arteritis) rarely cause glomerulonephritis, these diseases are important causes of renal vasculitis as well [3] [4].

• Collapse

  The associations among human immunodeficiency virus (HIV) infection, focal segmental glomerulosclerosis, and its variant, "collapsing glomerulopathy," often leading to chronic renal failure, are well described. [ncbi.nlm.nih.gov]

  Rheumatology (Oxford) 40 : 831 – 832, 2001 Major GA, Moore PG: Profound circulatory collapse due to azathioprine. J R Soc Med 78 : 1052 – 1053, 1985 Cunningham T, Barraclough D, Muirden K: Azathioprine-induced shock. [cjasn.asnjournals.org]

• Decreased Breath Sounds

  On examination, he was hemodynamically stable with BP 131/79 mmHg, there were decreased breath sounds in the right mid-zone, and he had proximal weakness. [cjasn.asnjournals.org]

• Hypertension

  Our results demonstrated that more hypertensive patients and higher BVAS were found in patients with AKI-F than those in other groups (p CONCLUSIONS: The RILFE criteria is a valid measurement of both prognosis and progression in patients with AASV. [ncbi.nlm.nih.gov]

  Percutaneous angioplasty in clinical management of renovascular hypertension: initial and long-term results. ‏ [books.google.com]

  Current Opinion in Nephrology and Hypertension: March 1993 Clinical nephrology: PDF Only Abstract During most of the 20th century, the medical literature on systemic vasculitis has been dominated by “splitters,” who sought to characterize the precise [journals.lww.com]

  The prevalence of hypertension in cases of Takayasu’s arteritis was lower in our dataset than in other studies ( 2, 9 ). [tidsskriftet.no]

To make the diagnosis of vasculitis, it is necessary to obtain a thorough patient history and conduct a detailed physical examination. If hematuria is noted, parameters of kidney function - creatinine, blood urea nitrogen (BUN), and serum electrolytes should be evaluated [5]. Furthermore, determination of proteinuria, as well as the presence of red and white blood cells, casts, and crystals can be achieved by simple urine testing and are valid indicators of glomerular damage [5]. Detection of anti-neutrophil cytoplasmic antibodies (both perinuclear and cytoplasmic, or p-ANCA and c-ANCA, respectively) in serum may be of a great help in making the diagnosis of small vessel vasculitis, but large titers are observed in all cases of ANCA-associated vasculitides, necessitating additional procedures to confirm the underlying disease [5]. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used as adjunctive procedures, but the use of a contrast needs to be avoided, as further damage to the kidneys may occur [5]. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is an important imaging study if solid clinical suspicion of vasculitis exists, mainly because it shows which organs are affected by vasculitis [2]. To confirm the diagnosis, the kidney biopsy is the gold standard [2]. Segmental fibrinoid necrosis, an absence of immune deposits in the glomeruli (as seen in pauci-immune glomerulonephritis), and the presence of glomerular crescents are frequently present in ANCA-associated glomerulonephritis [2] [3].

• Air Bronchogram

  Air bronchograms are evident. No cavitation is present. A clinical diagnosis of Wegener's granulomatosis (WG) complicated by pulmonary hemorrhage and dialysis-dependent renal failure was made. [cjasn.asnjournals.org]

• Microalbuminuria

  Typical findings of diabetic nephropathy are early hyperfiltration followed by microalbuminuria and overt proteinuria, resulting in a progressive decrease in glomerular filtration rate. [ncbi.nlm.nih.gov]

  Eight patients had either a normal protein–creatinine ratio or microalbuminuria, 17 had proteinuria and 11 had nephrotic proteinuria. Estimated glomerular filtration rate. [tidsskriftet.no]

• Creatinine Decreased

  Mean values of serum anti-MPO, disease activity markers and serum creatinine decreased when these values were compared from pre-therapy to the time of switching to MMF, and then to the end of the study anti-MPO: 204 A /- 144 U, 54 A /- 85 U and 12 A / [ncbi.nlm.nih.gov]

1. Walters G, Willis NS, Craig JC. Interventions for renal vasculitis in adults. Cochrane Database Syst Rev. 2015;9:CD003232.
2. Rowaiye OO, Kusztal M, Klinger M. The kidneys and ANCA-associated vasculitis: from pathogenesis to diagnosis. Clin Kidney J. 2015;8(3):343-350.
3. John R, Herzenberg AM. Vasculitis affecting the kidney. Semin Diagn Pathol. 2009;26(2):89-102.
4. Maritati F, Iannuzzella F, Pavia MP, Pasquali S, Vaglio A. Kidney involvement in medium- and large-vessel vasculitis. J Nephrol. 2016;29(4):495-505.
5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.