Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis presenting with severe acute kidney injury (AKI), consistent with rapidly progressive glomerulonephritis portends significant renal morbidity with up to 20%–25% of patients reaching end stage renal disease within a few years after diagnosis. Nevertheless, a smaller proportion of patients require dialysis at presentation or within the first six months. There is still some debate as to the first line therapy of choice for such patients vis a vis the use of the newer agent rituximab versus the time-tested cyclophosphamide in combination with glucocorticoids. Our recent experience at The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA in June 2018 allowed us to revisit this controversy.
Highlights
In January 2011, the Boards of Directors of the American College of Rheumatology (ACR), the American Society of Nephrology (ASN), and the European League Against Rheumatism (EULAR) recommended that the name “Wegener’s granulomatosis” be changed to “granulomatosis with polyangiitis,” abbreviated as GPA [1]
The preponderance of cumulative evidence from various clinical trials has suggested that rituximab, a chimeric murine/human anti-CD20 monoclonal antibody that was first introduced to treat GPA in 2001 is an effective alternative to cyclophosphamide for both induction immunosuppressive therapy and for maintenance of remission [6]
Younger patients with concerns about fertility may opt for rituximab
Summary
Rituximab in ANCA-associated vasculitis presenting with severe acute kidney injury; a case report. Macaulay Onuigbo1* ID , Julius Seok, Ikenna Anyamene, Fortunate Ejimone, Chinenye Eze-Raphael, In-Ah Vanessa Park. Article History: Received: 7 October 2018 Accepted: 14 December 2018 ePublished: 9 January 2019
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