Acute renal disease in vasculitis

Vasculitis is commoner than supposed, since its manifestations are Protean. A simple classification of vasculitis is outlined and an approach to renal vasculitis described. Recent papers on the subject are summarized, and recent advances in understanding of the role of cell-mediated immunity in the pathogenesis of vasculitis outlined. The treatment of renal vasculitis accompanied by renal insufficiency is summarized, with a note on Henoch-Schönlein purpura. The prognosis for patients with severe renal vasculitis, whether Wegener's granuloma or microscopic polyarteritis, has improved considerably over the past three decades, using immunosuppression with corticosteroids, orally or intravenously, cytotoxic agents, and plasma exchange backed up by dialysis as necessary. The principal problems now relate to the management of immunosuppression in the long term survivors.