Hemorrhagic complications associated with PR3-ANCA crescentic glomerulonephritis

Cao, Yuelong; Tian, Zhigang; Li, Wenge; Yang, Yanfei; Wang, Guochun

doi:10.3109/0886022x.2015.1014756

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…The detailed relationship between vasculitis and nontraumatic RSH has not been proven or fully discussed. Some non-traumatic RSH cases with vasculitis have been reported, including anti-neutrophil cytoplasmic antibody (ANCA) -associated vasculitis (7)(8)(9), systemic lupus erythematosus (SLE) (10)(11)(12)(13), and polyarteritis nodosa (14) (Table 2). Many of these patients had active vasculitis and received high-dose steroids either for the initial treatment or for recurrences.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis

Nakanoh,

Takeuchi,

Morimoto

et al. 2024

Intern. Med.

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A 68-year-old woman was admitted to our hospital because of a rapid progression of renal dysfunction with positive myeloperoxidase antineutrophil cytoplasmic antibody and was diagnosed with rapidly progressive glomerulonephritis associated with microscopic polyangiitis (MPA). Severe right rectus sheath hematoma (RSH) bleeding from the inferior epigastric artery developed after starting hemodialysis, which required 4 transarterial embolizations due to recurrent bleeding. After additional treatment with methylprednisolone pulse therapy and rituximab, no rebleeding occurred. Although the giant hematoma reached the pelvis, it shrank spontaneously without any intervention. Nontraumatic RSH should therefore be considered when treating patients with multiple risk factors.

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Section: Discussionmentioning

confidence: 99%

Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis

Nakanoh,

Takeuchi,

Morimoto

et al. 2024

Intern. Med.

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“…The presence of DAH is associated with higher mortality and is a predictor of poor outcome 1. Therefore, it is of utmost importance to establish the correct diagnosis and initiate the appropriate therapy as soon as possible 6…”

Section: Discussionmentioning

confidence: 99%

Pulmonary–renal syndrome: diagnostic challenge

Correia¹,

Eira

Cruz

et al. 2019

BMJ Case Rep

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Vasculitis presents several diagnostic challenges. Herein, we present a clinical case of a 71- year old woman, observed in our emergency department due to asthenia, vomiting and persistent cough. The patient had a history of progressive renal failure and anaemia over the last years. On physical examinations, fine pulmonary crackles were detected and laboratory test showed haemoglobin 69 g/L, creatinine 4 mg/dL, potassium 6.3 mmol/L, positive antineutrophil cytoplasm antibody (ANCA), with proteins and dimorphic erythrocytes in the urinary sediment. CT analysis of the thorax revealed patchy ground glass haziness, likely due to diffuse alveolar haemorrhage. Pulmonary–renal syndrome was assumed, and induction therapy was initiated. She was discharged after 33 days of hospitalisation. On the following months, ANCA titres remained undetectable, but minor recovery of renal function was observed, requiring haemodialysis. Indeed, the use of aggressive induction therapy at early stage dramatically improve prognosis, maintenance of disease remission may be difficult, as relapse is frequent.

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“…There were no preexisting medical comorbidities reported that would have predisposed her to an intracranial hemorrhage, suggesting that this was a complication of severe GPA. This complication has been reported in GPA in the nonpregnant population, however, is more common in MPA and EGPA [ 37 , 38 ]. The second maternal death was in the context of severe respiratory infection and ARDS as a complication of MPA [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a systematic review on maternal, pregnancy and fetal outcomes

Veltri

Hladunewich

Bhasin

et al. 2018

Clinical Kidney Journal

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Background De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians.MethodsWe conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy. Cochrane, Embase and PubMed databases and relevant conference abstracts were searched. Patient demographics, clinical presentation, management and outcomes (maternal, fetal and pregnancy-related) were analyzed.ResultsTwenty-seven cases of de novo AAV in pregnancy were included. Women presented were from 5 to 39 weeks' gestation, of which a majority were in the second trimester (median 20 weeks). The median gravida of women was 2 and the median parity was 1. Women were treated with steroids (89%), cyclophosphamide (CYC) (37%), other immunosuppressive agents [azathioprine (AZA), IVIG, plasma exchange (PLEX)] or no therapy (11%). High rates of serious complications, including preeclampsia (29%) and maternal death (7%), were reported; however, most pregnancies resulted in live birth (73%). Prematurity was common; 73% of live births occurred prior to 37 weeks’ gestation and 40% prior to 34 weeks’ gestation. The majority of infants were born in the third trimester (median 34.5 weeks). Rates of pregnancy termination were high (23%) and only one intrauterine death was reported, shortly after initiation of therapy (4%). Congenital abnormalities were rare, with one infant having a solitary, pelvic kidney (6%) after maternal treatment with steroids, CYC and PLEX. Use of PLEX, IVIG and AZA increased after 2005, whereas CYC use decreased. Remission often occurred postpartum (60%).Conclusions De novo AAV in pregnancy can result in uncomplicated pregnancies; however, serious maternal risks exist. Further data on potentially pregnancy compatible therapies such as IVIG and rituximab are needed in this population.

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Hemorrhagic complications associated with PR3-ANCA crescentic glomerulonephritis

Abstract: Hemorrhagic complications of anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis are life-threatening conditions. Of these, alveolar hemorrhage is the most common and well-described hemorrhagic complication and is a prominent component of the pulmonary-renal syndrome.

Cited by 6 publications

References 40 publications

Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis

Successful Treatment for Life Threatening Recurrent Non-traumatic Rectus Sheath Hematoma in a Case with Microscopic Polyangiitis with Rapidly Progressive Glomerulonephritis

Pulmonary–renal syndrome: diagnostic challenge

De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a systematic review on maternal, pregnancy and fetal outcomes

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