Clinical Pathological And Prognosis Analysis Of ANCA-associated Vasculitis With Renal Damage And Case Report Of Posterior Reversible Encephalopathy Syndrome With Literature Review

Part Ⅰ Clinicopathological Analysis and Prognosis of ANCA-associated Vasculitis with Renal DamageObjective Analyzing the clinical pathological features and prognostic factors of ANCA(anti-neutrophil cytoplasmic antibody)associated vasculitis with renal damage.Methods The clinical and renal pathological data of 37 patients,diagnosed as ANCA-associated vasculitis with renal damage,were collected in the past five years.21 patients were performed renal biopsy,according to the presence or absence of immune complex deposition,and whether it is crescentic nephritis,to conduct subgroup analysis.37 patients were subgroup analyzed based on whether they were detached from dialysis.Results 35 of all the patients of serological ANCA were positive for p-ANCA.21 of37 patients were performed renal biopsy,10 patients with immune complex deposition were more common positive for ANA,11 patients without immune complex deposition were more obvious in reducing urine protein and increasing hemoglobin after the treatment.9 patients who were diagnosed as crescentic nephritis had lower hemoglobin and faster ESR at the time of onset.After 2-24 months of follow-up,15 patients relyed on long-term dialysis therapy and 22 patients detached from dialysis,lower hemoglobin and higher serum creatinine at the time of onset were showed in the long-term dialysis group.Conclusion Detection of ANCA is the main method for the discovery of ANCA-associated vasculitis.Whether renal tissue is associated with immune complex deposition has no relationship with prognosis.Hemoglobin and serum creatinine levels at onset may be important factors in predicting whether patients can get rid of dialysis.Part Ⅱ Two cases of systemic vessel vasculitis complicated with posterior reversible encephalopathy syndrome and literature reviewObjective To explore the clinical characteristics and threapies of posterior reversible encephalopathy syndrome(PRES)in patients with systemic vessel vasculitis(SVV)by analyzing their clinical manifestations,imaging data and reviewing the literature.Methods We observed the clinical manifestations and imaging data of 2 cases and reviewed 56 cases of SVV complicated with PRES,in order to summarize the clinical features of all 58 cases of SVV combined with PRES.Results 51 cases(88%)with clinical manifestations of hypertension,33 cases(57%)along with renal failure,44 cases(76%)were treated with immunosuppressive drugs or steroids.26 cases(45%)have headache,17 cases(29%)have nausea or vomiting,30cases(52%)with consciousness impairment,33 cases(57%)have visual disturbances,53cases(91%)with seizures.Brain MRI showed multiple lesions in the parietal lobe,occipital lobe,frontal lobe,temporal lobe,and cerebellar hemisphere,which were mainly distributed in the posterior circulation of the brain.After the treatment,most patients have a good prognosis.Conclusion PRES,a group of clinical and imaging syndromes,which is often associated with hypertension,renal failure,connective tissue disease,glucocorticoid and immunosuppressive applications.Patients in SVV combined with PRES usually get good prognosis by timely and effective treatment.