Nephrology Dialysis Transplantation, Vol 12, Issue 9 1874-1882, Copyright © 1997 by Oxford University Press
K El-Reshaid, M Kapoor, W El-Reshaid, J Madda and J Varro
Background. This study was conducted to examine
prospectively the epidemiological profile of renal disease associated with
microscopic polyangiitis (MPA) and classic polyarteritis nodosa (classic
PAN) in Kuwait and its clinicopathological correlation.
Methods. Between 1 January 1993 and 31 December 1996,
all patients referred to Al-Amiri renal centre were subjected to renal
biopsy and/or arteriography if they manifested systemic manifestations of
vasculitis or had rapid or unexplained renal failure with or without
proteinuria. Patients who fulfilled the criteria of MPA and classic PAN,
according to the Chapel Hill Consensus Conference (CHCC), were included in
the study. Results. Over those 4 years, 47 patients
were diagnosed as having such vasculitides, 22 of whom were Kuwaiti
nationals. This gave an average annual incidence of 45 cases/million adult
Kuwaiti nationals (95% CI, 27-64). Histological examination revealed
necrotizing glomerulonephritis (GN) in 11 patients and crescentic GN in 13,
while isolated small- and/or medium-sized arteritis were evident in six
more patients. In 10 of the remaining patients; bands of fibrosis
alternating with healthy renal tissue were seen and on arteriography
non-atherosclerotic stenoses, infarctions, and/or microaneurysms were
evident. The remaining seven patients were diagnosed by arteriography
alone, five of whom had bilateral small kidneys. Constitutional
manifestations of vasculitis were present in 32 patients (68%) and
multisystem involvement in 19 (40%). ANCA levels were high in 24 (55%) of
the 44 patients tested and seropositivity, as an antimyeloperoxidase, was a
constant finding. Only six patients presented with rapidly progressive
renal failure, while 31 presented with chronic renal disease, 18 of whom
had protein excretion in excess of 2 g/day.
Conclusions. These findings emphasize the limited role
of clinical assessment in establishing a definite diagnosis of renal
vasculitis and put in question its value in retrospective analysis of
causes of ESRD in different populations. Keywords:
arteriography classic polyarteritis nodosa; kidney biopsy; Kuwait;
microscopic polyangiitis; vasculitis
ORIGINAL ARTICLES
The spectrum of renal disease associated with microscopic polyangiitis and classic polyarteritis nodosa in Kuwait
Department of Medicine, Faculty of Medicine, PO Box 24923, 13110 Safat, Kuwait; Departments of Medicine, Pathology and Radiology, Al-Airi Hospital, Ministry of Health, Kuwait; Corresponding author
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