ANСA-ASSOCIATED VASCULITIS (MICROSCOPIC POLYANGITIS) WITH TREATMENT-RESISTANT, RAPIDLY PROGRESSIVE RENAL INJURY: A CLINICAL CASE

Shapoval І.І.¹, Shvets L.V.¹, Orlova I.V.¹, Kedyk I.O.¹, Bombela V.O.¹, Shkolina N.V.², Pivovarova N.P.², Stanislavchuk M.A.¹

• ¹Vinnytsia National Medical University named after M.I. Pirogov, Vinnytsia
• ²CNE «Vinnytsia Regional Clinical Hospital named after M.I. Pirogov of Vinnytsia Regional Council», Vinnytsia

Summary. We describe a case report of a 59-year-old female patient with ANCA-associated vasculitis in the form of MPA with refractory, rapidly progressive renal involvement. The disease progressed over a 6-month period with progressive weakness, oedema, and hematuria, leading to stage IV chronic kidney disease and nephrotic syndrome. The diagnosis of MPA was made based on positive myeloperoxidase (MPO) antibodies, renal biopsy showing PAUCI-immune glomerulonephritis with 50% crescents, and the 2022 ACR/EULAR criteria. One characteristic feature was the occurrence of 4 documented COVID-19 episodes within a year, supporting the hypothesis that repeated exposure to SARS-CoV-2 drives a cumulative immunopathological mechanism underlying vasculitis. Treatment consisted of pulse therapy with methylprednisolone and cyclophosphamide, followed by supportive care. Improvement in laboratory and clinical symptoms after 3 months resulted in only partial remission, necessitating further escalation of therapy. The case illustrates the need for screening for ANCA-associated vasculitis in patients with progressive renal damage after COVID-19 and for early diagnosis and immunosuppressive therapy to avoid irreversible renal damage.