ANCA-associated renal vasculitis - an update

ANCA-associated vasculitis (AAV) is a potentially life-threatening disease with frequent and often severe kidney involvement which may result in end-stage renal disease. Anti-PR3 and anti-MPO disease are genetically distinct diseases and may have a different pathogenesis. Recent discovery of new autoantibodies (anti-LAMP-2) and the role of complement activation in the pathogenesis of AAV could result in better monitoring of the activity of the disease and identification of new treatment targets. The outcome of patients with AAV has dramatically improved, but long-term mortality still remains relatively high partly due to effective but relatively toxic immunosuppressive treatment. Recent studies demonstrated that B-cell depletion with rituximab is comparable to cyclophosphamide as induction treatment in newly diagnosed AAV patients and better than cyclophosphamide in relapsing patients. Rituximab-based maintenance treatment is superior to standard treatment with azathioprine. The use of more targeted treatment will hopefully be translated into a better long-term outcome of AAV patients.