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    "textoCompleto" => "<p class="elsevierStylePara">To the Editor&#58;</p><p class="elsevierStylePara">The aim of this letter is to highlight a clinical phenomenon&#44; insufficiently recognized&#58; the ANCA-positive vasculitis with a subacute evolution&#46; We present a series of five patients with ANCA-positive systemic vasculitis and small-sized kidneys on diagnosis&#46;</p><p class="elsevierStylePara">All patients were women &#40;mean age 67 years&#41;&#46; Two of them had a history of arthralgias&#44; epistaxis&#44; severe anemia and repetitive miscarriages&#44; and one of them had bronchial asthma&#46; The clinical picture began with a constitutional syndrome&#46; In two cases it was accompanied by nicturia and in one by hemoptysis&#46; Mean CRP was 2&#46;4 &#177; 1&#46;8 mg&#47;dL&#46; Proteinuria in the non-nephrotic range &#40;maximum 1g&#47;24 hours&#41; and microhematuria with deformed red blood cells were present in all patients&#46;</p><p class="elsevierStylePara">Immunological investigations were negative except for ANCA&#44; which exhibited an anti-myeloperoxidase pattern&#46; On diagnosis&#44; the ultrasound revealed a decreased renal size with a maximal longitudinal axis of 9 cm in all cases&#46; A renal biopsy was performed in 3 patients&#44; which showed vasculitic lesions&#44; sclerosed glomeruli&#44; and intense interstitial fibrosis&#44; obviously related with the diminished renal size&#46; Three patients presented at least one episode of pulmonary hemorrhage&#44; and two patients died from infectious complications&#46; In three cases the condition evolved to end-stage renal disease requiring hemodialysis&#44; while the others were controlled with immunosuppressive drugs&#46; It is interesting that two patients had been diagnosed with nephroangiosclerosis and presented the first episode of pulmonary hemorrhage when they already were on hemodialysis&#46; This episode prompted the ANCA investigation&#46;</p><p class="elsevierStylePara">The reported cases are remarkable due to the coincidence of small sized kidneys and ANCA-positive vasculitis&#46; In this condition the usual presentation differs&#44; because the renal size is normal or perhaps bigger than normal as a consequence of the inflammatory reaction&#46; Renal vasculitis has usually a rapidly progressive evolution&#44; but it is evident that it sometimes evolves more torpidly&#44; with a slow worsening of renal function and few manifestations on urine sediment &#40;minimal proteinuria of microhematuria&#44; which initially go unrecognized&#41;&#46;<span class="elsevierStyleSup">1</span> Falk et al&#46; have recently pointed out that the disease can possibly evolve in flares of vasculitis&#44; with progressive glomerular lesions&#44; which can produce a late clinical picture&#44; when more than a half of the glomeruli are affected&#46; In this sense&#44; a glomerulonephritis evolving to CRD should never be considered as a mild condition&#46;<span class="elsevierStyleSup">2</span> If the clinical evolution is slow&#44; the episodes of focal necrosis resolve with glomerular scaring and sclerosis&#44; and at each flare new glomerular lesions are added&#46; That could explain the diminution of the renal size&#46;</p><p class="elsevierStylePara">It is possible that among patients who are on renal replacement therapy with a disease of unknown origin and with small kidneys on diagnosis&#44; some of them may have been diagnosed with nephroangiosclerosis and present&#44; positive ANCA antibodies and vasculitis with few clinical manifestations&#44; being susceptible to suffer from an episode of pulmonary hemorrhage while on hemodialysis program&#46; In this setting&#44; if the diagnosis is not clear&#44; at least an ANCA determination should be mandatory and profitable&#44; to avoid diagnostic failures with important consequences&#46; <br></br></p>"
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Small kidney in ANCA-positive renal vasculitis: a possible marker of subacute evolution
Riñón pequeño en vasculitis renal ANCA positiva: un posible marcador de evolución subaguda
S.. Alexandrua, A.. García-Péreza, C.. Carameloa, J.. Gómezb
a Servicio de Nefrología, Fundación Jiménez Díaz-Capio. Universidad Autónoma, Madrid, Madrid, España,
b Servicio de Medicina Interna, Fundación Jiménez Díaz-Capio. Universidad Autónoma, Madrid, Madrid, España,
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ISSN: 20132514
Original language: English
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