Onset of Microscopic Polyangiitis in Binephrectomied Patient on Chronic Hemodialysis-Case Report

Area of Science:

• Nephrology
• Rheumatology
• Immunology

Background:

• Microscopic polyangiitis (MPA) is a pulmonary-renal syndrome often linked to ANCA positivity.
• De novo MPA development in patients on chronic hemodialysis (HD) is rare and previously undescribed.
• MPA diagnosis typically involves ANCA positivity (50-75%) and inflammation markers.

Purpose of the Study:

• To report a novel case of de novo microscopic polyangiitis in a patient on chronic hemodialysis.
• To highlight the diagnostic challenges and successful management of MPA in this specific patient population.
• To emphasize the possibility of immune-mediated disease onset even after initiating renal replacement therapy.

Main Methods:

• Case report of a patient on chronic HD who developed MPO-ANCA-associated MPA.
• Diagnosis confirmed through clinical presentation (lung and musculoskeletal involvement) and MPO-ANCA positivity, without renal biopsy.
• Patient managed with standard immunosuppression therapy.

Main Results:

• The patient developed MPO-ANCA-associated MPA after 4 years of regular HD.
• Diagnosis was established by excluding other causes of MPO-ANCA positivity.
• The patient achieved and maintained remission for 27 months following immunosuppressive treatment.

Conclusions:

• Immune-mediated diseases like MPA can manifest after the initiation of renal replacement therapy.
• The onset of MPA in HD patients presents diagnostic challenges.
• Early diagnosis and conventional immunosuppressive therapy are effective for achieving remission in MPA.