MICROSCOPIC POLYANGIITIS AND KIDNEY INFLAMMATION
Keywords:microscopic polyangiitis, kidneys, lungs, skin, diagnosis, treatment
Introduction. Microscopic polyangiitis (MPA) is rare (approximately 13-19 cases per million population). MPA is a disease of unclear genesis associated with the production of antibodies to the cytoplasm of neutrophils and is characterized by combined inflammatory lesions of several organs, most often the lungs and kidneys, which is based on vasculitis of small vessels without the formation of granulomas.
Goal. Describe the clinical manifestations of microscopic polyangiitis with lesions of the lungs (pneumonitis) and kidneys (glomerulonephritis), analyze the dynamics of laboratory and instrumental parameters in a patient with rapid progression of renal failure.
Materials and methods. Review of modern and foreign sources, analysis and discussion of a specific clinical case; methods – description, analysis, abstracting.
Results and discussion. Given the recurrent polymorphic rash on the anterior surface of the thighs, chest in the form of a «décolleté», extensor surfaces of the upper extremities, accompanied (ambulatory card data) by an increase in ESR, CRP, CEC, lymphocytopenia; positive effect from treatment (in dermatologists) of corticosteroids; joint syndrome (oligoarthralgia with the inclusion of large joints, small joints of the hands) fever; lymphadenopathy (enlargement of the submandibular, cervical lymph nodes); kidney damage (increase in urea, creatinine, hematuria, proteinuria, cylindruria) lung damage (pneumonitis, pulmonary insufficiency), it is necessary to conduct a differential diagnosis between SLE, blood disease and systemic vasculitis (Goodpasture’s syndrome). The presence of atrophic rhinitis, pronounced inflammatory changes in blood tests, a positive response to treatment with corticosteroids, elevated levels of P-ANCA
allowed to diagnose microscopic polyangiitis, subacute course, ІІІ st. activity, with kidney damage (rapidly progressing glomerulonephritis, urinary syndrome, hematuric component, arterial hypertension l in, acute renal failure from 27.03.07, stage of recovery of diuresis) lungs (pulmonitis, LN ІІ-ІІІ st.) upper respiratory tract ) joints (arthralgia, FTS 0 st.) skin (chronic recurrent urticaria) of serous membranes (pleurisy, pericarditis); P-ANCA is positive.