ANCA-associated renal vasculitis

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ANCA-associated renal vasculitis Caroline O.S. Savage Kidney International Volume 60, Issue 4, Pages 1614-1627 (October 2001) DOI: 10.1046/j.1523-1755.2001.00962.x Copyright © 2001 International Society of Nephrology Terms and Conditions

Figure 1 ELISA for MPO-ANCA showing serial antibody titers (EU/mL) over time. Kidney International 2001 60, 1614-1627DOI: (10.1046/j.1523-1755.2001.00962.x) Copyright © 2001 International Society of Nephrology Terms and Conditions

Figure 2 Glomerulus in the patient's first renal biopsy showing an acute segmental lesion with thrombosis, disruption of capillary loops and adhesion of the tuft to Bowman's capsule. Periodic acid-methenamine silver (PA silver) ×250. Kidney International 2001 60, 1614-1627DOI: (10.1046/j.1523-1755.2001.00962.x) Copyright © 2001 International Society of Nephrology Terms and Conditions

Figure 3 Cortex in the patient's second renal biopsy showing acute segmental lesions in several glomeruli. PA silver ×50. Kidney International 2001 60, 1614-1627DOI: (10.1046/j.1523-1755.2001.00962.x) Copyright © 2001 International Society of Nephrology Terms and Conditions

Figure 4 Small artery in the patient's second renal biopsy showing localized destruction of the wall with acute inflammation. PA silver × 250. Kidney International 2001 60, 1614-1627DOI: (10.1046/j.1523-1755.2001.00962.x) Copyright © 2001 International Society of Nephrology Terms and Conditions

Figure 5 Stages in the initiation and development of vasculitic lesions. (A) Production of high-affinity ANCA IgG from plasma cells. The events leading to this are unclear but are likely to require T-cell help within lymphoid tissues. (B) Circulating neutrophils (PMN) and vascular endothelial cells (EC) are in a resting (r) state until: (C) infection leads to local generation of cytokines such as TNFα, which prime neutrophils (pPMN) to surface-express PR3 or MPO [0] and induce endothelial cell activation (AcEC); (D) ANCA bind and activate neutrophils (AcPMN) following engagement of antigen [by F(ab)2] and FcγR (by Fc). PMN become adherent with EC through adhesion molecule interactions. Release of reactive oxygen radical and inflammatory mediators (cytokines, proteases →) from PMN and EC initiates endothelial damage. Anti-endothelial cell antibodies may contribute to EC activation. (E) Released IL-8 causes delay of PMN migration and/or retention of AcPMN within the microcirculation. Primed PMN undergo accelerated apoptosis in response to ANCA and progress to secondary necrosis (nPMN) within the microcirculation. Intravascular thrombosis and EC necrosis develop (nEC). PR3 binding to EC may contribute. Amplification of inflammation follows recruitment of mononuclear cells (monocytes, T-cells) into lesions. Kidney International 2001 60, 1614-1627DOI: (10.1046/j.1523-1755.2001.00962.x) Copyright © 2001 International Society of Nephrology Terms and Conditions