AUTHOR=Jankovic Aleksandar , Maslarevic-Radovic Vesna , Djuric Petar , Tosic-Dragovic Jelena , Bulatovic Ana , Simovic Nikola , Mitrovic Milos , Stankovic-Popovic Verica , Dopudja-Pantic Vesna , Arandjelovic Snezana , Dimkovic Nada TITLE=Onset of Microscopic Polyangiitis in Binephrectomied Patient on Chronic Hemodialysis—Case Report JOURNAL=Frontiers in Immunology VOLUME=8 YEAR=2017 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2017.00111 DOI=10.3389/fimmu.2017.00111 ISSN=1664-3224 ABSTRACT=Introduction

Microscopic polyangiitis (MPA) is one of the causes of the pulmonary–renal syndrome associated with elevated non-specific markers of inflammation and antineutrophil cytoplasmic autoantibody (ANCA) positivity in 50–75%. De novo occurrence of the disease in patients on chronic hemodialysis (HD) has not been described.

Case presentation

We presented patient who developed MPO-ANCA-associated MPA with lung and musculoskeletal involvement after 4 years on regular HD due to bilateral nephrectomy. After excluding the other causes of MPO-ANCA positivity, diagnosis was confirmed even without renal biopsy. Patient received standard immunosuppression therapy and he is still in remission after 27 months.

Conclusion

The onset of immune-mediated disease could be observed even after introduction of renal replacement therapy, which may be a diagnostic problem. Early recognition and traditional immunosuppressive regiment may provide successful outcome.