Vasculitis — Renal Involvement

Several systemic vasculitides can involve the kidney, generally presenting as a glomerulonephritis with haematuria ± proteinuria, and eventually CKD if the disease becomes chronic.

If a serious ANCA-associated disease is suspected, early diagnosis is life-saving given the risk of significant kidney damage: perform urinalysis for haematuria/proteinuria; if positive, order ANCA; if positive, refer urgently.

Conditions with renal involvement

• Polyarteritis nodosa — kidney impairment and hypertension; multi-system involvement (arthralgia, weight loss, fever, ± skin lesions) points to this diagnosis
• Microscopic polyangiitis (ANCA-associated)
• Granulomatosis with polyangiitis (formerly Wegener’s, ANCA-associated) — glomerulonephritis eventually develops in ~80% of patients within 2 years of disease onset
• IgA vasculitis (Henoch-Schönlein purpura)

See rheumatology’s dedicated pages for the fuller systemic presentation of each condition — this page covers the renal-specific angle only.