Long-term follow-up characteristics of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) receiving chronic hemodialysis at a single center

A Ruptured Jejunal Arterial Aneurysm in a Young Woman Undergoing Chronic Hemodialysis Due to Myeloperoxidase-antineutrophil Cytoplasmic Antibody-associated Vasculitis

“…Recently, it was reported that an increase in ANCAs is strongly related to a relapse in patients with renal involvement, whereas an increase in ANCAs is only weakly associated with a relapse in patients with nonrenal disease ( 6 ). More recently, this was confirmed in Japanese hemodialysis patients with ANCA-associated glomerulonephritis ( 33 ). Although the pathogenesis is not known, the ANCA titer did not rise at the time of the MPO-AAV flare-up in our dialysis patient.…”

“…Moreover, the use of steroid therapy for longer than 6 months is reported to be associated with a significantly increased risk of infection but not a significant reduction in the risk of relapse ( 38 ). On the other hand, it has been reported that the relapse rate was significantly lower after initiating chronic dialysis than before initiating chronic dialysis ( 33 , 39 - 41 ). Considering the older age of patients with AAV receiving chronic dialysis in Japan, Miyabe et al recommended that the early tapering of steroids should be considered to avoid death rather than focusing only on relapse ( 33 ).…”

“…On the other hand, it has been reported that the relapse rate was significantly lower after initiating chronic dialysis than before initiating chronic dialysis ( 33 , 39 - 41 ). Considering the older age of patients with AAV receiving chronic dialysis in Japan, Miyabe et al recommended that the early tapering of steroids should be considered to avoid death rather than focusing only on relapse ( 33 ). These recommendations might not be adaptable to our young dialysis patient taking 5 mg/day prednisolone at the time of relapse 34 months after the initiation of remission induction therapy.…”