Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Kidney Disorders- The following article discusses about a medical condition called Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis. This condition causes renal dysfunction. In this article, we will discuss about various causes, symptoms, and treatment rendered for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis.

Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

How Is Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis Defined?

  • Autoimmune Disease- Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis is an autoimmune disease that results in vascular tissue inflammation and systemic vasculitis.
  • Antibodies- Autoimmune response by the body is triggered by autoantibodies. Antibodies react against the antigen present in the wall of neutrophils granulocytes and blood vessels.1
  • Immune System- Antibodies are protein molecule that circulates in the blood. Antibodies are produced by the immune system of the body to fight and terminate bacteria and viruses. Protein molecules located over wall of bacteria and viruses are treated as antigen.
  • Autoimmune Disease- Sometimes antibodies react against normal cells, which are part of tissue and organs. In other words antibodies start attacking own cells and triggers autoimmune disease. These antibodies are called as autoantibodies. The autoantibodies react against antigen or protein molecules of cellular wall of cells of blood vessels and neutrophils.1
  • ANCA Against Neutrophils- Anti-Neutrophil Cytoplasmic Autoantibody or ANCA are autoantibodies, which attacks certain type of white blood cells namely neutrophils (neutrophil granulocytes) and activates the white blood cells.
  • The antigen and antibody reaction causes inflammatory reaction of blood vessels also known as vasculitis. Vasculitis changes the function of the blood vessel. Vasculitis causes irregular exchange of electrolytes, water and waste product in kidney.
  • Anti-Neutrophil Cytoplasmic Autoantibody induces vasculitis of renal blood vessels and causes excessive leakage of blood, minerals, water and protein into urine collected by renal tubule. The disease may cause end stage renal disease and kidney failure.

Causes Of Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

  • Cause of autoimmune reaction and antibody secretion is not known
  • Research has not confirmed but hypothesis is the disease is triggered by gene mutation. The malfunction of gene controlling immune system is probable cause of beginning of autoimmune antibody secretion.
  • Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis is caused as a result of the autoantibodies causing inflammatory vasculitis and inflammatory edema of blood vessels
  • The antibody reaction with antigen of capillaries and small arteriole activates neutrophils to attack the capillaries and blood vessels resulting in vasculitis. Vasculitis of kidney vessels and glomeruli results in a medical condition called glomerulonephritis.2

Types Of Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis can attack different organ structures. The different forms of Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis affecting the kidneys are:

  • Renal Limited Vasculitis or ANCA Glomerulonephritis: In this, swelling of the blood vessels causes capillary swelling. Apart from the kidneys, no other organs are affected in this form of vasculitis.
  • Microscopic Polyangiitis: In this, swelling causes injury/damage to blood vessels in numerous tissues at once. This form is usually seen in the kidneys, nerves, and lungs.

What Are The Chances Of An Individual Getting Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis?

  • Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis is an extremely rare condition.
  • Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis generally strikes people who are above 55 years of age.
  • There is no gender bias with this disorder but research has shown it usually affects the whites more.

Symptoms Of Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Non-Specific Symptoms Of ANCA Vasculitis-

  • Flu-like Symptoms
    • Fever
    • Body and muscle pains
    • Fatigue and malaise
  • Decreased appetite
  • Unintentional weight loss.

Specific Symptoms Of ANCA Vasculitis-

Generalized vasculitis can cause specific symptoms related to organ involved. Most common organ involved is kidney.

Renal Vasculitis- Renal vasculitis may result in Crescent Glomerulonephritis.

  • Polyuria
  • Proteinuria
  • Hypokalemia
  • Lesion

Wegener's Granulomatosis- Affects blood vessels of kidney and lungs. Symptoms are same as above and additional symptoms caused by lung vasculitis are as follows-

  • Cough
  • Rhinorrhea
  • Epistaxis
  • Sinusitis
  • Hemoptysis
  • Dyspnea
  • Life-threatening pulmonary hemorrhage.

Chrug-Strauss Syndrome

  • Non-Specific symptoms
  • Skin rash
  • Cough
  • Diarrhea
  • Gastrointestinal bleeding
  • Bleeding in lung
  • Abdominal severe pain
  • Numbness in hands and feet.

Pulmonary Vasculitis-

  • Vasculitis of the blood vessels of the lungs
  • Cough
  • Hemoptysis- Coughing blood
  • Dyspnea- Short of breath

Pulmonary Renal Vasculitis-4

  • Bleeding in lungs
  • Symptoms and signs of renal vasculitis.

Diagnosis for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Detailed Examination for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

  • Physician conducts a detailed physical examination

Urine Examination for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Urine examination may show following abnormalities.

  • Abnormal Creatinine Clearance
  • Blood in urine
  • Proteinuria
  • Check and estimate excretion of Urine Total Protein
  • Uric acid in urine
  • Abnormal Urine concentration test
  • Abnormal Specific Gravity of urine

Blood Examination for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

The following blood tests are abnormal in case of Glomerulonephritis:

  • Blood BUN and Creatinine is increased.
  • Positive serum Anti-Glomerular Basement Membrane Antibody are observed,
  • Positive Antineutrophil Cytoplasmic Antibodies
  • Antinuclear Antibodies is increased.
  • Complement Levels are increased.
  • Anti-Neutrophil Cytoplasmic Antibody (ANCA) Blood Test is increased.
  • Tests to look for specific infections such as hepatitis B or hepatitis C.

Radiological Studies for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Some of the radiological studies that may be done to confirm the diagnosis of vasculitis of lung, gastrointestinal system and kidney are as follows:

  • CT scan of the kidney, lung and abdomen
  • MRI of the kidney, lung and abdomen
  • Intravenous Pyelogram

Ultrasound Studies for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

  • Ultrasound study is performed to examine the kidney, lung and gastrointestinal organs to diagnose shape and external surface of the organ and hematoma (blood clots).

Biopsy for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

  • Kidney biopsy and Microscopic examination is performed to confirm diagnosis of glomerulonephritis.

Bronchoscopy and lavage for Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

  • Rarely bronchoscopy is performed to check the trachea, bronchi and lungs.
  • The secretions of lungs are collected during bronchoscopy for lab and microscopic study.

Treatment For Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

Referral to Specialist- Referral depends on organs affected by vasculitis.

  • Vasculitis of Kidney- Nephrologist
  • Vasculitis of Lungs- Pulmonologist
  • Vasculitis of Gastrointestinal (GI) System- GI Specialist

Steroids:

A steroid helps in controlling swelling and slows down the autoimmune response.5

Immunosuppressant Medications:

  • Medications like cyclophosphamide and cyclosporine prevents the immune system's to attack itself.5

Antibiotics:

  • These medications treat the infections that are caused as a result of vasculitis,
  • Antibiotics may remove triggering bacteria and viruses from system, which are initiating Anti-Neutrophil Cytoplasmic Autoantibody formations.

Renal Failure-

  • Unfortunately, there are some patients who even with definite treatment do not improve and end up having renal failure. In such cases, kidney transplant becomes an option.

Some Important Queries Regarding Kidney Transplant In Anti-Neutrophil Cytoplasmic Autoantibody (ANCA) Vasculitis

When it comes to kidney transplant as a result of Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis, patients may have the following queries which have been answered below:

What are the Chances of Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis Recurring Even After Kidney Transplant?

There are instances in about 15% of people where the disease has recurred after the transplant; hence, it is imperative to make sure that Anti-Neutrophil Cytoplasmic Autoantibody disease is completely inactive prior to undergoing a kidney transplant. This significantly reduces the chances of disease recurrence after the transplant. Usually, Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis symptoms may return after about five years after the kidney transplant.6

What Is The Potential Treatment For Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis In Case It Returns After A Kidney Transplant?

The treatment remains the same even after a kidney transplant but in this case the medications may be different in order to prevent kidney rejection.

In case Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis Recurs, Can It Result In The Failure Of Transplant?

It is very rare that Anti-Neutrophil Cytoplasmic Autoantibody Vasculitis causes loss of the transplant. Research suggests that only about 7% of people lose their kidneys after transplant after approximately 10 years post transplantation due to Anti-Neutrophil Cytoplasmic Autoantibody.

References

1. B cell-mediated pathogenesis of ANCA-mediated vasculitis.

Jennette JC1, Falk RJ.

Semin Immunopathol. 2014 Apr 29.

2. Pathogenesis of lung vasculitis.

Nachman PH1, Henderson AG.

Semin Respir Crit Care Med. 2011 Jun;32(3):245-53.

3. Alveolar haemorrhage in ANCA-associated vasculitides: 80 patients' features and prognostic factors.

Kostianovsky A1, Hauser T, Pagnoux C, Cohen P, Daugas E, Mouthon L, Miossec P, Cordier JF, Guillevin L; French Vasculitis Study Group (FVSG).

Clin Exp Rheumatol. 2012 Jan-Feb;30(1 Suppl 70):S77-82.

4. Pulmonary renal vasculitis syndromes.

Lee RW1, D'Cruz DP.

Autoimmun Rev. 2010 Aug;9(10):657-60. doi: 10.1016/j.autrev.2010.05.012.

5. Plasmapheresis therapy for diffuse alveolar hemorrhage in patients with small-vessel vasculitis.

Klemmer PJ1, Chalermskulrat W, Reif MS, Hogan SL, Henke DC, Falk RJ.

Am J Kidney Dis. 2003 Dec;42(6):1149-53.

6. Recurrent ANCA-associated vasculitis after renal transplantation.

Dhaun N, Blakeney J, Richards A, Bellamy CO, Kluth DC.

Transplantation. 2010 Dec 15;90(11):1239-40.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 6, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

Symptom Checker

Slideshow:  Home Remedies, Exercises, Diet and Nutrition

Chakra's and Aura's

Yoga Information Center

Find Pain Physician

Subscribe to ePainAssist Newsletters

By clicking Submit, I agree to the ePainAssist Terms & Conditions & Privacy Policy and understand that I may opt out of ePainAssist subscriptions at any time.

Copyright © 2016 ePainAssist, All rights reserved.

DMCA.com Protection Status