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Renal Medullary Angiitis Associated with Cutaneous Leukocytoclastic Vasculitis

Shoko Miura1, Kan Katayama2, Kensuke Joh3

  • 1Department of Nephrology, Kuwana City Medical Center, Japan.

Internal Medicine (Tokyo, Japan)
|November 5, 2023
PubMed

Insights

Renal medullary angiitis, a rare condition causing kidney bleeding and neutrophil infiltration, was diagnosed in an elderly man with vasculitis. Treatment with steroids and plasma exchange led to clinical improvement.

Area of Science:

  • Nephrology
  • Pathology
  • Rheumatology

Background:

  • Renal medullary angiitis is a rare vasculitic condition.
  • It is characterized by interstitial hemorrhaging and neutrophil infiltration in the renal medulla.

Purpose of the Study:

  • To present a case of renal medullary angiitis in an elderly male patient.
  • To highlight the diagnostic challenges and treatment outcomes.

Main Methods:

  • Case report of an 81-year-old male with fever, kidney dysfunction, and purpura.
  • Diagnostic workup included serological tests (Proteinase 3 antineutrophil cytoplasmic antibodies), kidney biopsy with immunofluorescence, and electron microscopy.
  • Treatment involved intravenous methylprednisolone, plasma exchange, and oral prednisolone.

Main Results:

  • The patient presented with symptoms suggestive of leukocytoclastic vasculitis.
  • Kidney biopsy revealed severe tubulointerstitial hemorrhaging and neutrophilic infiltration in the medulla, without glomerular crescents.
  • Immunofluorescence and electron microscopy ruled out immunoglobulin A vasculitis.
  • The patient showed clinical improvement after treatment.

Conclusions:

  • Renal medullary angiitis can present as kidney dysfunction and purpura in the elderly.
  • A comprehensive diagnostic approach is crucial to differentiate it from other vasculitides.
  • Prompt treatment with corticosteroids and plasma exchange can lead to favorable outcomes.
Keywords:
anti-neutrophil cytoplasmic antibodyinterstitial hemorrhagingleukocytoclastic vasculitisrenal medullary angiitisvasa recta

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