What is vasculitis and how is it related to the kidneys?
Angiitis (or vasculitis) is a group of autoimmune diseases characterized by inflammation and damage to the walls of various blood vessels. This gradually results in the vessels rupture or its stenosis and blockage. The vessels and organs affected vary depending on the type of vasculitis. The damage caused may be transient or permanent.
What causes vasculitis?
The causes for most of the vasculitis are not known, that is, they are idiopathic. But some infections may play a key role in the appearance of some types of angiitis, such as hepatitis B, hepatitis C that predispose to some types of vasculitis. But some medications or some other autoimmune diseases (e.g. SLE or rheumatoid arthritis) can also cause vasculitis.
What are its symptoms?
Vasculitis is a group of diseases with a very heterogeneous clinical picture, depending on the type of vessels and the organ involved. For example, when renal involvement occurs, there is evidence of microscopic or macroscopic hematuria, acute renal failure, hypertension. If the skin is involved, red spots may appear on the skin, or even in more “neglected” cases, skin ulceration, etc. may occur.
I have vasculitis. Can it affect my kidneys?
It depends on the type of vasculitis. Some vasculitis can cause kidney damage. Your nephrologist will perform the necessary tests to determine if kidney damage is involved. The test includes a general urinalysis, the control of the renal function by examining the levels of creatinine in the blood. If kidney involvement is detected, a kidney biopsy may be required for a more accurate diagnosis.
What are the major vasculitides related to the kidneys?
Two are the main ones:
Wegener with polyangiitis (GPA), formerly known as Wegener granulomatosis (WG): a rare disease characterized by an infection of the upper and lower respiratory tract, systemic vasculitis of small and medium-sized vessels and kidney involvement with necrotizing glomerulonephritis (inflammation of the kidney glomerulus in 75-80% of patients).
-Microscopic polyangiitis: with the same range of clinical manifestations as Wegener's granulomatosis. 90% of patients experience glomerulonephritis which affects other organs such as skin (40%), lungs (50%), nasopharynx (35%), musculoskeletal (60%), neural (30%).
Is there a cure?
Yes, there is treatment, especially if the diagnosis is made early before significant damage to the target organs of the vasculitis occurs. Fortunately, vasculitis - although relatively rare - is highly detected by doctors when there are many organs involved. Early onset of the appropriate treatment ensures better progression and prognosis. There are several therapeutic regimens that target the body's immune system such as cortisone and other immunomodulatory regimens (cyclophosphamide, methotrexate, azathioprine, younger biological agents, etc.). Treatment often has 2 stages, the one that aims to instantly "erase" inflammation and that of maintenance designed to reduce vasculitis recurrence. Another form is plasmapheresis, a specialized treatment that aims to remove the antibodies that cause vasculitis from the patient's blood. It has evidence in more severe conditions, such as severe kidney failure.
Mesogeios Dialysis Centers Group Scientific Team
1.Grau RG. Drug-Induced Vasculitis: New Insights and a Changing Lineup of Suspects. Curr Rheumatol Rep. 2015 Dec;17(12):71. doi: 10.1007/s11926-015-0545-9. Review. PubMed PMID: 26503355.
2. Cojocaru M, Cohocaru IM, Chico B. New insight into the rheumatoid vasculitis. Rom J Intern Med. 2015 Apr-Jun;53(2):128-32. Review. PubMed PMID: 26402981.
3.Teng GG, Chatham WW. Vasculitis related to viral and other microbial agents. Best Pract Res Clin Rheumatol. 2015 Apr;29(2):226-43. doi: 10.1016/j.berh.2015.05.007. Epub 2015 Jun 11. Review. PubMed PMID: 26362741.
4. Sharma A, Dogra S, Sharma K. Granulomatous Vasculitis. Dermatol Clin. 2015 Jul;33(3):475-87. doi: 10.1016/j.det.2015.03.012. Review. PubMed PMID: 26143427.
5.Lally L, Sammaritano LR. Vasculitis in antiphospholipid syndrome. Rheum Dis Clin North Am. 2015;41(1):109-23, ix. doi: 10.1016/j.rdc.2014.09.009. Review. PubMed PMID: 25399943.
6. Barile-Fabris L, Hernández-Cabrera MF, Barragan-Garfias JA. Vasculitis in systemic lupus erythematosus. Curr Rheumatol Rep. 2014;16(9):440. doi: 10.1007/s11926-014-0440-9. Review. PubMed PMID: 25023725.
7.Hoffman GS, Calabrese LH. Vasculitis: determinants of disease patterns. Nat Rev Rheumatol. 2014 Aug;10(8):454-62. doi: 10.1038/nrrheum.2014.89. Epub 2014 Jun 17. Review. PubMed PMID: 24934189.
8. Della Rossa A, Cioffi E, Elefante E, Ferro F, Parma A, Vagelli R, Talarico R. Systemic vasculitis: an annual critical digest of the most recent literature. Clin Exp Rheumatol. 2014 May-Jun;32(3 Suppl 82):S98-105. Epub 2014 May 15. Review. PubMed PMID: 24854379.
9. Miloslavsky E, Unizony S. The heart in vasculitis. Rheum Dis Clin North Am. 2014 Feb;40(1):11-26. doi: 10.1016/j.rdc.2013.10.006. Review. PubMed PMID: 24268007.
10.Monach PA. Biomarkers in vasculitis. Curr Opin Rheumatol. 2014 Jan;26(1):24-30. doi: 10.1097/BOR.0000000000000009. Review. PubMed PMID:24257367; PubMed Central PMCID: PMC4015522.