caa a22 4500 445883820 CHVBK 20180317145553.0 cr unu---uuuuu 170323e20110401xx s 000 0 eng 10.1007/s10157-010-0386-9 doi (NATIONALLICENCE)springer-10.1007/s10157-010-0386-9 An autopsy-proven case of myeloperoxidase-antineutrophil cytoplasmic antibody-positive polyarteritis nodosa with acute renal failure and alveolar hemorrhage [Elektronische Daten] [Yusuke Sakaguchi, Takuya Uehata, Hiroaki Kawabata, Kakuya Niihata, Akihiro Shimomura, Akira Suzuki, Tetsuya Kaneko, Tatsuya Shoji, Kohki Shimazu, Hiroaki Fushimi, Yoshiharu Tsubakihara] An 80-year-old woman positive for myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was admitted with a 3-month history of fever, general malaise, and weight loss, after unsuccessful treatment with antibiotics. Upon admission, her fever persisted, and there was concomitant deterioration of renal function without active urine sediments. Furthermore, she developed hemoptysis, and chest computed tomography (CT) scan revealed bilateral diffuse alveolar hemorrhage. Although a renal biopsy was not performed because of her dementia, we initially suspected microscopic polyangiitis (MPA) on the basis of her clinical course. Because of her poor general condition, she was administered a low dose of prednisolone. Although her fever subsided, she suffered from intractable alveolar hemorrhage and eventually died from respiratory failure. During the autopsy, fibrinoid necrosis was restricted to medium-sized arteries, including the arcuate arteries of the kidneys and the bronchial arteries, without necrotizing crescentic glomerulonephritis and alveolar capillaritis. Therefore, polyarteritis nodosa (PAN) was diagnosed. It is important to distinguish between MPA and PAN because they can lead to life-threatening complications, and their treatment strategies and prognosis are different. When a patient presents with MPO-ANCA, alveolar hemorrhage, and acute renal failure with little evidence of glomerulonephritis, a differential diagnosis of PAN should be made; however, it is difficult to do so without pathological findings. Therefore, pathological examination should be carried out whenever possible. Japanese Society of Nephrology, 2010 Myeloperoxidase-antineutrophil cytoplasmic antibody nationallicence Polyarteritis nodosa nationallicence Acute renal failure nationallicence Alveolar hemorrhage nationallicence Sakaguchi Yusuke Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Uehata Takuya Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, B6 2-2 Yamada-oka, 565-0871, Suita, Japan aut Kawabata Hiroaki Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Niihata Kakuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Shimomura Akihiro Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Suzuki Akira Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Kaneko Tetsuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Shoji Tatsuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Shimazu Kohki Department of Pathology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Fushimi Hiroaki Department of Pathology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Tsubakihara Yoshiharu Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut Clinical and Experimental Nephrology Springer Japan 15/2(2011-04-01), 281-284 1342-1751 15:2<281 2011 15 10157 https://doi.org/10.1007/s10157-010-0386-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10157-010-0386-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Sakaguchi Yusuke Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Uehata Takuya Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, B6 2-2 Yamada-oka, 565-0871, Suita, Japan aut NATIONALLICENCE 700 1- Kawabata Hiroaki Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Niihata Kakuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Shimomura Akihiro Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Suzuki Akira Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Kaneko Tetsuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Shoji Tatsuya Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Shimazu Kohki Department of Pathology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Fushimi Hiroaki Department of Pathology, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 700 1- Tsubakihara Yoshiharu Department of Kidney Disease and Hypertension, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, 558-8558, Osaka, Japan aut NATIONALLICENCE 773 0- Clinical and Experimental Nephrology Springer Japan 15/2(2011-04-01), 281-284 1342-1751 15:2<281 2011 15 10157 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer