Insuficiencia Renal Asociada Poliangeítis Microscópica

Abstract

Microscopic polyangiitis (PAM) is a rare idiopathic autoimmune disease that by not granulomatous small or medium vessels, necrotizing systemic vasculitis associated with the presence of antineutrophil cytoplasmic antibodies (Anti-Neutrophil Cytoplasmic Antibodies, ANCA) is characterized with both pulmonary and renal involvement. (1) Cause renal dysfunction predominantly by severe glomerular inflammation and kidney failure. The diagnosis is based on clinical manifestations, the result of biopsies of lesions, the positivity of ANCA and justifying if a patient with systemic vasculitis of small vessels pauci-immune no evidence of necrotizing granulomatous inflammation or asthma. The vast majority of patients with ANCA-associated vasculitis reach the temporary control of the disease with immunosuppressive therapy currently available. (4) The case of a female patient aged 61 presented with a history of chronic renal failure of unknown cause in substitute treatment of renal function 6 months ago. With box frank hemoptysis accompanied by hemodynamic compromise associated with the presence of polyarthralgia several months of evolution, fatigue and weight loss.

Physical examination lung auscultation highlights the presence of bilateral crackles disseminated. additional tests where severe anemia, increased bilirubin at the expense of indirect, in peripheral blood smear fragmentocitosis in lung CT scan showed alveolar hemorrhage is observed is performed. Given the history of renal failure of unknown cause associated with more anemia respiratory disorders hemolytic suspected in an immunological disease with both renal disease such as pulmonary, immunological studies antineutrophil cytoplasmic antibodies (ANCA) indicated these being positive with perinuclear pattern (ANCA P), moving towards small vessel vasculitis ANCA positive, manejándose as a microscopic poliangeítitis.