Features of acute nephritis, focal necrosis with/without crecents, and rapidly progressive renal failure over weeks; treatable cause of acute renal failure
Aetiology ANCA positive → ANCA-associated Vasculitis Systemic vasculitis - GPA, microscopic polyangiitis ANCA negative Goodpasture's disease - anti-GBM HSP SLE Clinical presentation Rapid deterioration in renal function over days/weeks Active urinary sediment (RBCs, RBC and granular casts) May be part of systemic disease Investigations Urine - active urinary sediment (RBCs, RBC and granular casts) Renal biopsy - glomerular cresents Management Immunosuppression Steroids - IV methylprednisolone/oral prednisolone Cytotoxics - cyclophosphamide/mycophenolate/azathioprine Supportive care including dialysis if needed
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