Relapsing p-ANCA positive vasculitis with lung hemorrhage in a patient on hemodialysis
Recidiva de vasculitis p-ANCA positiva con hemorragia pulmonar en paciente en hemodiálisis.
Read
10058
Timeswas read the article
3399
Total PDF
6659
Total HTML
Share statistics
array:21 [ "pii" => "X2013251408005482" "issn" => "20132514" "doi" => " " "estado" => "S300" "fechaPublicacion" => "2008-08-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2008;28:457-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5265 "formatos" => array:3 [ "EPUB" => 287 "HTML" => 4251 "PDF" => 727 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699508005485" "issn" => "02116995" "doi" => " " "estado" => "S300" "fechaPublicacion" => "2008-08-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2008;28:457-60" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14536 "formatos" => array:3 [ "EPUB" => 285 "HTML" => 13301 "PDF" => 950 ] ] "es" => array:11 [ "idiomaDefecto" => true "titulo" => "Recidiva de vasculitis p-ANCA positiva con hemorragia pulmonar en paciente en hemodiálisis." "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "457" "paginaFinal" => "460" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Relapsing p-ANCA positive vasculitis with lung hemorrhage in a patient on hemodialysis" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jose L Merino, Cristina Galeano, Judith Martins, Julio Pascual, Jose L Teruel, Joaquin Ortuño" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jose L" "apellidos" => "Merino" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "Galeano" ] 2 => array:2 [ "nombre" => "Judith" "apellidos" => "Martins" ] 3 => array:2 [ "nombre" => "Julio" "apellidos" => "Pascual" ] 4 => array:2 [ "nombre" => "Jose L" "apellidos" => "Teruel" ] 5 => array:2 [ "nombre" => "Joaquin" "apellidos" => "Ortuño" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251408005482" "doi" => " " "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408005482?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699508005485?idApp=UINPBA000064" "url" => "/02116995/0000002800000004/v0_201502091416/X0211699508005485/v0_201502091417/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251408005603" "issn" => "20132514" "doi" => " " "estado" => "S300" "fechaPublicacion" => "2008-08-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2008;28:461" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3550 "formatos" => array:3 [ "EPUB" => 291 "HTML" => 2689 "PDF" => 570 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "About PTH measurement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "461" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "ACERCA de la medida de PTH" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. J. Martín Gil" "autores" => array:1 [ 0 => array:2 [ "Iniciales" => "F. J." "apellidos" => "Martín Gil" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699508005606" "doi" => " " "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699508005606?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408005603?idApp=UINPBA000064" "url" => "/20132514/0000002800000004/v0_201502091636/X2013251408005603/v0_201502091636/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251408005490" "issn" => "20132514" "doi" => " " "estado" => "S300" "fechaPublicacion" => "2008-08-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2008;28:453-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4460 "formatos" => array:3 [ "EPUB" => 277 "HTML" => 3605 "PDF" => 578 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Thrombocytopenia in a patient on peritonela dialysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "453" "paginaFinal" => "455" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "TROMBOCITOPENIA EN UN PACIENTE EN DIÁLISIS PERITONEAL" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "BELÉN PASCUAL ORTIN, MIGUEL ANGEL SOLIS SALGUERO, VERONICA RAMOS BODI, ISABEL JUAN GARCÍA, ISIDRO TORREGROSA MAICAS, RAFAEL GARCÍA RAMÓN, ALFONSO MIGUEL CARRASCO" "autores" => array:7 [ 0 => array:2 [ "nombre" => "BELÉN" "apellidos" => "PASCUAL ORTIN" ] 1 => array:2 [ "nombre" => "MIGUEL ANGEL" "apellidos" => "SOLIS SALGUERO" ] 2 => array:2 [ "nombre" => "VERONICA" "apellidos" => "RAMOS BODI" ] 3 => array:2 [ "nombre" => "ISABEL" "apellidos" => "JUAN GARCÍA" ] 4 => array:2 [ "nombre" => "ISIDRO" "apellidos" => "TORREGROSA MAICAS" ] 5 => array:2 [ "nombre" => "RAFAEL" "apellidos" => "GARCÍA RAMÓN" ] 6 => array:2 [ "nombre" => "ALFONSO MIGUEL" "apellidos" => "CARRASCO" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699508005493" "doi" => " " "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699508005493?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408005490?idApp=UINPBA000064" "url" => "/20132514/0000002800000004/v0_201502091636/X2013251408005490/v0_201502091636/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "titulo" => "Relapsing p-ANCA positive vasculitis with lung hemorrhage in a patient on hemodialysis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "457" "paginaFinal" => "460" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Jose L Merino, Cristina Galeano, Judith Martins, Julio Pascual, Jose L Teruel, Joaquin Ortuño" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jose L" "apellidos" => "Merino" "email" => array:1 [ 0 => "jmerino.hrc@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Cristina" "apellidos" => "Galeano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Judith" "apellidos" => "Martins" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Julio" "apellidos" => "Pascual" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "nombre" => "Jose L" "apellidos" => "Teruel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 5 => array:3 [ "nombre" => "Joaquin" "apellidos" => "Ortuño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, Madrid, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Recidiva de vasculitis p-ANCA positiva con hemorragia pulmonar en paciente en hemodiálisis." ] ] "textoCompleto" => "INTRODUCTION <br></br><br></br>ANCA are serological markers directed against several components of neutrophil cytoplasm, and are considered activity factors in necrosing pauci-immune vasculitis such as Wegener granulomatosis, microscopic polyangiitis, or <br></br>Churg-Strauss syndrome.1,2 p-ANCA-positive vasculitis may cause isolated renal damage or involve other target organs, particularly the lung, in which latter case it is called pulmonary-renal syndrome.3 Relapse is not very common and even less in patients on dialysis.4 The need for renal replacement treatment is not frequent either.5 Immunosuppressive treatment and dialysis itself increase the risk of infectious complications. 6 Relapse of a p-ANCA vasculitis with pulmonaryrenal involvement during chronic hemodialysis treatment is reported. <br></br><br></br>CASE REPORT <br></br><br></br>A73-year-old female patient. She had been admitted to hospital four years before for hemoptysis and hematuria with kidney function impairment (Cr 7 mg/dL), high blood pressure, and constitutional syndrome. She had proteinuria with microhematuria and blood casts, and positive p-ANCA (39 U) were found in her immunological study, that was otherwise negative (c-ANCA, anti-GBM, cryoglobulins, HBV, HCV and HIV serology, lupus anticoagulant, and antiphospholipid antibodies). A renal biopsy showed fibrous occlusive crescents in glomeruli, with ischemic lesions in the vascular tangle, intact arterial vessels, and severe interstitial fibrosis with lymphoplasmocyte <br></br>infiltration. Immunofluorescence was negative. Patient was diagnosed of p-ANCA-positive vasculitis with pulmonary-renal involvement and type III extracapillary proliferative glomerulonephritis (pauci-immune). Treatment was then started with intravenous boluses of 6-methylprednisolone, followed by prednisone (1 mg/kg/day) and oral cyclophosphamide at a dose of 1.5 mg/kg/day. Cyclophosphamide was discontinued at one month of treatment due to leukopenia, and azathioprine was started and continued for 2 years. Steroid treatment was tapered to discontinuation during the first year. Though clinical response was favorable, kidney function did not normalize and renal replacement treatment was required 3 years after diagnosis. No complications occurred during this time, except for a trend to leukopenia, and p-ANCA remained negative. One year after the start of hemodialysis, the patient experienced isolated hemoptysis with no fever or other related clinical signs. Physical examination revealed a BP of 120/70 mmHg, crackling sounds in the right base on auscultation, no edema or data suggesting volume overload, and no skin lesions or other remarkable changes. Laboratory tests results included: Hb: 11.8 g/dL, hematocrit: 36%, WBC: 7400 (N: 83%, L: 7%); platelets: 376,000, normal hemostasis, albumin; 3.9 g/dL, normal liver profile, ferritin: 120 ng/mL, PTH: 155 pg/mL, and negative serological tests for HCV, HBV, and HIV. Immunological study was positive for p-ANCA (33.3 U) and negative for all other parameters, with normal complement. Chest X-rays revealed the presence of diffuse, bilateral cottony infiltrates (fig. 1) and a CT scan of the chest showed diffuse peripheral bilateral lung involvement, mainly at the bases, with heterogeneous opacities. No cavitations or calcifications were seen (fig. 2). Based on the findings and on the evidence of disease relapse, treatment was started with steroid bolus (3 days, 250 mg IV), followed by oral prednisone at a dose of 1 mg/kg/day with subsequent tapering, and oral cyclophosphamide (1.5 mg/kg/day). After one month of treatment, the patient experienced a new episode of leukopenia that required cyclophosphamide discontinuation. Clinical course was however favorable, with disappearance of hemoptysis at 40 days of treatment and radiographic normalization at 3 weeks. One year later, she is on a tapering steroid treatment and has experienced no new episodes of hemoptysis. Titer of p-ANCA became negative at 2 months. <br></br><br></br>DISCUSSION <br></br><br></br>Small vessel vasculitis with positive ANCAmay cause the socalled pulmonary-renal syndrome.7,8 The most common cause of this condition is a Goodpasture syndrome, followed by Wegener¿s granulomatosis,5,9 though some series have reported more than 50% of cases to be associated to ANCA-positive pauci-immune glomerulonephritis.7 Our patient had a pulmonary- renal syndrome with positive p-ANCA and pauci-immune glomerulonephritis on initial diagnosis, and experienced a subsequent relapse while on hemodialysis (HD). <br></br><br></br>Advanced age, high blood pressure, or existence of proteinuria or impaired kidney function (serum creatinine > 4.5 <br></br>mg/dL) on initial diagnosis are risk factors for the development of chronic renal failure (CRF) and the need for replacement therapy. The Kaplan-Pavlovcic study on 37 elderly patients with rapidly progressive glomerulonephritis and positive ANCA supported these risk factors.10 The European Group for the Study of Vasculitis (EUVAS) subsequently documented that a decreased glomerular filtration rate and chronic pathological lesions at the time of diagnosis are powerful predictors for the development of end-stage renal disease.11 Chronic end-stage renal failure occurs in approximately 20% of patients with pauci-immune vasculitis.6 <br></br><br></br>The existence of respiratory tract involvement is in turn associated to a poorer prognosis.12 In a retrospective study of 14 patients with pulmonary-renal syndrome, Gallagher and colleagues showed a 36% mortality rate, with 85% and 67% survival rates after the first and second years respectively.3 In another study of 22 patients with pulmonary-renal syndrome and small vessel vasculitis, the mortality rate at the end of the study reached 50%.13 In a large retrospective study conducted by Weidner et al on 80 patients with similar characteristics, a 26% mortality rate was reported. One- and 5-year survival rates were 86% and 81% respectively. These authors found an overall relapse rate of 33%, similar to other studies.14 <br></br><br></br>Disease recurrence after HD is started or a kidney transplant (KT) is received is not clear. Mechanisms altering immune response, particularly cell-mediated immune response, in these patients are multiple, but continue to be ill-defined.15 In the Gera et al study on 35 patients with vasculitis and positive ANCA undergoing KT, only 3 relapses with no renal involvement were seen, and no clear risk factor could be evidenced. 16 In a prior study by Roasting on 8 patients with similar characteristics and KT, only one relapse with pulmonary-renal involvement was seen.17 Other studies found similar favorable results, but reported that immunosuppressive treatment does not fully protect from relapse.18,19 <br></br><br></br>Recurrence while on HD has rarely been reported. In the retrospective study of case series conducted by Weidanz et al, among the 46 patients in whom recurrence was analyzed, a lower relapse rate was seen in patients on HD as compared to pre-dialysis patients with a similar condition (0.05 vs 0.13 relapses/patient/year), though the number of infections was higher in the HD group.4 Recurrence on HD may range from 10%-30% per patient/year depending on the study, and is more common than in KT patients.6,20 <br></br><br></br>Treatment of relapses occurring in either KT or HD patients does not differ from standard treatment. Allen, in a <br></br>retrospective review of 59 patients with vasculitis and associated ANCA who were on HD or had received a KT, noted that relapse usually responded to cyclophosphamide and steroids.20 Booth et al, in a multicenter, retrospective study on a cohort of 246 patients, showed that relapse occurred in 34% of their patients and reported that, though medical treatment had improved prognosis, morbidity and mortality continued to be high, particularly in association to leukopenia, that was found in up to 41% of cases.21 The European group (EUVAS) designed a randomized study including 155 patients with vasculitis and positive ANCA with the objectives of minimizing complications and optimizing treatment. This group concluded that replacement of cyclophosphamide by azathioprine in the remission phase did not increase the risk of relapse.22 Other therapeutic options have not been adequately documented yet. Conventional treatment was started with steroids and cyclophosphamide for the relapse occurring in our patient. The trend to leukopenia required discontinuation of cyclophosphamide and advised <br></br>against use of azathioprine. The relapse was associated to a new increase in autoantibody titers, but the test became negative after immunosuppressive treatment. <br></br><br></br>The value of antibodies for monitoring disease activity in patients on HD is controversial. In the Weidemann et al crosssectional study of 1277 patients on HD, positive p-ANCA and c-ANCA titers with no evidence of vasculitis were found in 5% of cases.23 Positive ANCA with no disease were also seen in another study of 335 patients, 176 of whom were on HD, and positive titers were related to an increased cytokine formation in patients on dialysis.24 Other studies, such as those by Gordon and Gaskin, reported conflicting results regarding the presence of antibodies in disease relapses.25,26 <br></br><br></br>To sum up, vasculitis is uncommon, but is associated to significant complications and to a poor outcome in many <br></br>cases. However, relapse is not common, and even less so in kidney transplant and hemodialysis patients. Patients on HD are treated similarly to those without HD, but have a greater risk of infectious complications because of leukopenia. The value of ANCA titers as activity markers in hemodialysis has not been defined yet. <br></br>" "pdfFichero" => "P-E-S-A394-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440881" "palabras" => array:1 [ 0 => "Hemorragia pulmonar" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440883" "palabras" => array:1 [ 0 => "Pauciinmune" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440885" "palabras" => array:1 [ 0 => "Vasculitis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440887" "palabras" => array:1 [ 0 => "p-ANCA" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440889" "palabras" => array:1 [ 0 => "Semiluna" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440891" "palabras" => array:1 [ 0 => "Diálisis" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440882" "palabras" => array:1 [ 0 => "Pulmonary hemorrahge" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440884" "palabras" => array:1 [ 0 => "Pauciinmune" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440886" "palabras" => array:1 [ 0 => "Vascullitis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440888" "palabras" => array:1 [ 0 => "p-ÁNCA" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440890" "palabras" => array:1 [ 0 => "Crecentic" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440892" "palabras" => array:1 [ 0 => "Dialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "Las recaídas en el curso de las vasculitis p-ANCA en los pacientes en diálisis son poco frecuentes. Revisamos el caso de una paciente diagnosticada de vasculitis p-ANCA que desarrolló una recaída con síndrome reno-pulmonar un año después de iniciar tratamiento sustitutivo con hemodiálisis. El tratamiento con esteroides y ciclofosfamida controló el cuadro, pero ésta última hubo de suspenderse por leucopenia. Se discuten los cuadros de vasculitis con afectación renal y ulterior recaída en diálisis, la utilidad de los títulos de ANCA para predecir esas recaídas y las opciones terapéuticas." ] "en" => array:1 [ "resumen" => "Relapses of p-ANCA vasculitis during chronic dialysis treatment are infrequent. We report a patient with a pulmonary-renal syndrome and p-ANCA vasculitis who relapsed one year after starting hemodialysis treatment. Treatment with steroids and cyclosphosphamide successfully controlled the relapse, though cyclophosphamide had to be discontinued because of leucopenia. Clinical features of renal vasculitis, relapse after dialysis, the usefulness of ANCA titles as possible predictors and therapeutic options are discussed." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[i] Vizjak A, Rott T, Koselj-Kajtna M, Rozman B, Kaplan-Pavlovcic S, Ferluga D. Histologic and immunohistologic study and clinical presentation of ANCA-associated glomerulonephritis with correlation to ANCA antigen specificity. Am J Kidney Dis. 2003;41:539-49. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12612976" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[iii] Gallagher H, Kwan JT, Jayne DR. Pulmonary renal syndrome: a 4-year, single-center experience. Am J Kidney Dis. 2002;39:42-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11774100" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[v] Jennette, JC. Rapidly progressive crescentic glomerulonephritis. Kidney Int 2003; 63:1164-77. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12631105" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[vii] Niles, JL, Bottinger, EP, Saurina, GR, et al. The syndrome of lung hemorrhage and nephritis is usually an ANCA-associated condition. Arch Intern Med 1996; 156:440-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8607730" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[ix] Boyce, NW, Holdsworth, SR. Pulmonary manifestations of the clinical syndrome of acute glomerulonephritis and lung hemorrhage. Am J Kidney Dis 1986; 8:31-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/3728460" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xi] Hauer HA, Bajema IM, Van Houwelingen HC, et al; European Vasculitis Study Group (EUVAS) Determinants of outcome in ANCA-associated glomerulonephritis: a prospective clinico-histopathological analysis of 96 patients. Kidney Int. 2002;62:1732-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12371974" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xiii] Stangou M, Asimaki A, Bamichas G, Christidou F, Zoumbaridis N, Natse T, Galanis N, Christaki P, Patakas D, Sombolos K. Factors influencing patient survival and renal function outcome in pulmonary-renal syndrome associated with ANCA (+) vasculitis: a single-center experience. J Nephrol. 2005;18:35-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15772921" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xv] Descamps-Latscha B, Jungers P, Witko-Sarsat V. Blood Purif. Immune system dysregulation in uremia: role of oxidative stress. 2002; 20:481-4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xvii] Rostaing L, Modesto A, Oksman F, Cisterne JM, Le Mao G, Durand D. Outcome of patients with antineutrophil cytoplasmic autoantibody-associated vasculitis following cadaveric kidney transplantation. Am J Kidney Dis. 1997; 29:96-102. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9002536" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xix] Nachman PH, Segelmark M, Westman K, Hogan SL, Satterly KK, Jennette JC, Falk R. Recurrent ANCA-associated small vessel vasculitis after trasplantation: A pooled analysis. Kidney Int. 1999; 56:1544-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10504506" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xxi] Booth AD, Almond MK, Burns A, Ellis P, Gaskin G, Neild GH, Plaisance M, Pusey CD, Jayne DR; Pan-Thames Renal Research Group. Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study. Am J Kidney Dis. 2003;41:776-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12666064" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xxiii] Weidemann S, Andrassy K, Ritz E. ANCA in haemodialysis patients. Nephrol Dial Transplant. 1993;8:839-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8255517" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "[xxv] Gordon M, Luqmani RA, Adu D, Greaves I, Richards N, Michael J, Emery P, Howie AJ, Bacon PA. Relapses in patients with a systemic vasculitis. Q J Med. 1993; 86:779-789 <a href="http://www.ncbi.nlm.nih.gov/pubmed/7906421" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002800000004/v0_201502091636/X2013251408005482/v0_201502091636/en/main.assets" "Apartado" => array:4 [ "identificador" => "35422" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002800000004/v0_201502091636/X2013251408005482/v0_201502091636/en/P-E-S-A394-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251408005482?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 11 | 19 |
| 2024 October | 40 | 71 | 111 |
| 2024 September | 49 | 70 | 119 |
| 2024 August | 62 | 95 | 157 |
| 2024 July | 35 | 51 | 86 |
| 2024 June | 76 | 61 | 137 |
| 2024 May | 70 | 68 | 138 |
| 2024 April | 54 | 51 | 105 |
| 2024 March | 42 | 34 | 76 |
| 2024 February | 30 | 54 | 84 |
| 2024 January | 43 | 30 | 73 |
| 2023 December | 40 | 44 | 84 |
| 2023 November | 83 | 38 | 121 |
| 2023 October | 53 | 58 | 111 |
| 2023 September | 38 | 35 | 73 |
| 2023 August | 32 | 53 | 85 |
| 2023 July | 49 | 86 | 135 |
| 2023 June | 30 | 72 | 102 |
| 2023 May | 45 | 109 | 154 |
| 2023 April | 32 | 67 | 99 |
| 2023 March | 30 | 96 | 126 |
| 2023 February | 28 | 48 | 76 |
| 2023 January | 43 | 52 | 95 |
| 2022 December | 51 | 49 | 100 |
| 2022 November | 42 | 55 | 97 |
| 2022 October | 41 | 71 | 112 |
| 2022 September | 37 | 50 | 87 |
| 2022 August | 41 | 62 | 103 |
| 2022 July | 33 | 55 | 88 |
| 2022 June | 36 | 47 | 83 |
| 2022 May | 55 | 37 | 92 |
| 2022 April | 55 | 60 | 115 |
| 2022 March | 61 | 76 | 137 |
| 2022 February | 34 | 69 | 103 |
| 2022 January | 42 | 49 | 91 |
| 2021 December | 40 | 48 | 88 |
| 2021 November | 29 | 46 | 75 |
| 2021 October | 51 | 52 | 103 |
| 2021 September | 28 | 43 | 71 |
| 2021 August | 54 | 54 | 108 |
| 2021 July | 66 | 52 | 118 |
| 2021 June | 49 | 34 | 83 |
| 2021 May | 36 | 35 | 71 |
| 2021 April | 55 | 25 | 80 |
| 2021 March | 52 | 40 | 92 |
| 2021 February | 44 | 24 | 68 |
| 2021 January | 36 | 20 | 56 |
| 2020 December | 27 | 18 | 45 |
| 2020 November | 28 | 18 | 46 |
| 2020 October | 40 | 20 | 60 |
| 2020 September | 19 | 10 | 29 |
| 2020 August | 36 | 13 | 49 |
| 2020 July | 34 | 19 | 53 |
| 2020 June | 31 | 16 | 47 |
| 2020 May | 42 | 14 | 56 |
| 2020 April | 26 | 26 | 52 |
| 2020 March | 30 | 6 | 36 |
| 2020 February | 35 | 18 | 53 |
| 2020 January | 44 | 21 | 65 |
| 2019 December | 38 | 25 | 63 |
| 2019 November | 28 | 25 | 53 |
| 2019 October | 28 | 11 | 39 |
| 2019 September | 27 | 22 | 49 |
| 2019 August | 52 | 9 | 61 |
| 2019 July | 51 | 20 | 71 |
| 2019 June | 47 | 10 | 57 |
| 2019 May | 58 | 11 | 69 |
| 2019 April | 110 | 31 | 141 |
| 2019 March | 65 | 17 | 82 |
| 2019 February | 43 | 22 | 65 |
| 2019 January | 36 | 13 | 49 |
| 2018 December | 89 | 34 | 123 |
| 2018 November | 103 | 23 | 126 |
| 2018 October | 78 | 28 | 106 |
| 2018 September | 66 | 17 | 83 |
| 2018 August | 50 | 25 | 75 |
| 2018 July | 49 | 16 | 65 |
| 2018 June | 61 | 11 | 72 |
| 2018 May | 64 | 20 | 84 |
| 2018 April | 72 | 8 | 80 |
| 2018 March | 55 | 17 | 72 |
| 2018 February | 51 | 15 | 66 |
| 2018 January | 37 | 7 | 44 |
| 2017 December | 61 | 18 | 79 |
| 2017 November | 62 | 21 | 83 |
| 2017 October | 67 | 13 | 80 |
| 2017 September | 62 | 16 | 78 |
| 2017 August | 64 | 8 | 72 |
| 2017 July | 58 | 13 | 71 |
| 2017 June | 55 | 12 | 67 |
| 2017 May | 80 | 18 | 98 |
| 2017 April | 42 | 18 | 60 |
| 2017 March | 35 | 8 | 43 |
| 2017 February | 43 | 19 | 62 |
| 2017 January | 31 | 18 | 49 |
| 2016 December | 80 | 15 | 95 |
| 2016 November | 79 | 14 | 93 |
| 2016 October | 113 | 13 | 126 |
| 2016 September | 136 | 6 | 142 |
| 2016 August | 215 | 6 | 221 |
| 2016 July | 208 | 20 | 228 |
| 2016 June | 132 | 0 | 132 |
| 2016 May | 161 | 0 | 161 |
| 2016 April | 84 | 0 | 84 |
| 2016 March | 84 | 0 | 84 |
| 2016 February | 107 | 0 | 107 |
| 2016 January | 107 | 0 | 107 |
| 2015 December | 107 | 0 | 107 |
| 2015 November | 98 | 0 | 98 |
| 2015 October | 99 | 0 | 99 |
| 2015 September | 74 | 0 | 74 |
| 2015 August | 78 | 0 | 78 |
| 2015 July | 92 | 0 | 92 |
| 2015 June | 43 | 0 | 43 |
| 2015 May | 66 | 0 | 66 |
| 2015 April | 6 | 0 | 6 |
Show all
