Your patient had PR3 elevated, not anti-MPO. That is very unusual. I was surprised to see crescents in the bx normal creatinine. Good case. Thank you for sharing.
Welcome back Dr Timothy. Thank you for your nice case. Actually, your series help me a lot in my work (I'm a nephrology specialist). I wonder if you could present at least two cases every month instead of one case>>>
Sometimes both MPO and PR3 will be positive, particularly in drug-induced ANCA-related processes. When these antibodies come in high titers and are usually accompanied by other antibodies - ANA, anti-histone, etc - so worth testing for.
Definitely. Hydralazine induced ANCA vasculitis is usually pan-positive serologies (ANA, histone, ANCA, etc.) They were checked in this patient, but were negative.
We stopped the methimazole, and actually ended up giving her prednisone and cyclophosphamide because shortly after the kidney biopsy her Cr started rising (actually peaked at 2.5). Eventually got her in remission, and Cr stabilized at 1.4 - not perfectly normal still. Because we felt it was drug induced, we did not give her longterm maintenace therapy and she is sti ll doing well several years out without relapse.
Your patient had PR3 elevated, not anti-MPO. That is very unusual. I was surprised to see crescents in the bx normal creatinine. Good case. Thank you for sharing.
Need transplant biopsy cases with banff classification AmR TCR with exact grading..plz make some vedio lectures on transplant biopsy scoring
Very nice case thank you
Welcome back Dr Timothy. Thank you for your nice case. Actually, your series help me a lot in my work (I'm a nephrology specialist). I wonder if you could present at least two cases every month instead of one case>>>
I wish I had time to do more, but for now the most I can handle with my other commitments is to do about one/month!
Good
why was this not Wegeners? The lung biopsy didnt show the usual findings I know that, but maybe it was unsampled or something.
Sometimes both MPO and PR3 will be positive, particularly in drug-induced ANCA-related processes. When these antibodies come in high titers and are usually accompanied by other antibodies - ANA, anti-histone, etc - so worth testing for.
Definitely. Hydralazine induced ANCA vasculitis is usually pan-positive serologies (ANA, histone, ANCA, etc.) They were checked in this patient, but were negative.
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Thanks for the upload! How did you treat the pt? Just stopped the drug or opted to go for bigger guns?
We stopped the methimazole, and actually ended up giving her prednisone and cyclophosphamide because shortly after the kidney biopsy her Cr started rising (actually peaked at 2.5). Eventually got her in remission, and Cr stabilized at 1.4 - not perfectly normal still. Because we felt it was drug induced, we did not give her longterm maintenace therapy and she is sti
ll doing well several years out without relapse.