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Acute Pyelonephritis II: Diagnostic Studies and Management01:28

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Microscopic polyangiitis: a large single-center series.

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Microscopic polyangiitis (MPA) frequently involves the lungs, often presenting with respiratory symptoms like cough and infiltrates. This study highlights the high prevalence of pulmonary issues in MPA patients, urging better interdisciplinary care.

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Area of Science:

  • Rheumatology
  • Pulmonology
  • Nephrology

Background:

  • Microscopic polyangiitis (MPA) is a rare systemic vasculitis associated with antineutrophil cytoplasmic antibodies.
  • Characterized by necrotizing small vessel vasculitis, MPA commonly affects the kidneys and lungs.
  • Pulmonary capillaritis leading to alveolar hemorrhage and hemoptysis is recognized, but often underemphasized in literature focused on renal aspects.

Purpose of the Study:

  • To review pulmonary manifestations in microscopic polyangiitis (MPA) over a decade.
  • To emphasize initial and subsequent pulmonary involvement in MPA patients with specific antibody positivity.
  • To highlight the frequency of pulmonary symptoms beyond alveolar hemorrhage.

Main Methods:

  • A single-center, 10-year retrospective review of 40 patients meeting the 2012 Revised Chapel Hill Nomenclature for MPA.
  • Patient charts were reviewed using International Classification of Diseases, Ninth Revision codes for vasculitis.
  • Data on initial presentation, pulmonary manifestations, and treatment were analyzed.

Main Results:

  • The onset of MPA was typically abrupt, with respiratory symptoms being common, and cough the most frequent initial complaint.
  • Pulmonary complaints were present in 80% of patients at presentation, with 92% showing pulmonary infiltrates.
  • Hemoptysis occurred in 40% of patients during the illness course.

Conclusions:

  • Pulmonary involvement in MPA is significantly more common than previously reported (25-50%), especially when considering symptoms beyond hemorrhage.
  • Current evaluation and management guidelines for MPA are lacking.
  • Improved communication among pulmonary, nephrology, and rheumatology services is crucial for better disease understanding and patient care.