ANCA associated vasculitis.

Consider ANCA associated vasculitis (AAV) in people with chronic systemic symptoms and evidence of renal, pulmonary, ear, nose, and throat, ophthalmic, or peripheral nerve disease Perform urinalysis in people presenting with persistent systemic symptoms and in those with specific features of vasculitis (scleritis, chronic dyspnoea, cough, haemoptysis, foot drop) because these individuals have a high probability of multi-system disease Patients with haemoptysis plus other features of AAV warrant same day hospital assessment to evaluate for pulmonary haemorrhage Nicola, 44, goes to her general practitioner with a one month history of fatigue and night sweats. Physical examination is unremarkable. The duration of her symptoms prompts her GP to consider systemic inflammatory disease. Urinalysis is positive for blood and protein, and blood tests show new renal impairment (serum creatine 327 mol/L, estimated glomerular filtration rate (eGFR) 13 mL/min/1.73m 2 ) and evidence of an inflammatory response (C-reactive protein 50 mg/L, haemoglobin 103 g/L, platelets 46110 9 /L, albumin 33 g/L). Nicola is referred urgently to her local renal unit and undergoes kidney biopsy and testing for anti-neutrophil cytoplasmic antibodies (ANCA). She is diagnosed with ANCA-associated vasculitis.