Microscopic Polyangiitis Workup: Laboratory Studies, Imaging Studies, Other Tests (original) (raw)

Laboratory Studies

The complete blood cell count (CBC) in patients with microscopic polyangiitis (MPA) demonstrates leukocytosis and a normocytic anemia. The erythrocyte sedimentation rate (ESR) is elevated.

Kidney function test results are as follows:

Antineutrophil cytoplasmic antibody (ANCA) test results are as follows:

Blood cultures may be performed to rule out bacterial endocarditis. On complement testing, C3 and C4 levels are normal.

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Imaging Studies

Chest radiograph findings are as follows:

Pulmonary alveolar capillaritis.

Pulmonary alveolar capillaritis.

Other imaging studies may be indicated for the complications of the disease and specific organ system involvement. For example, abdominal computed tomography may be indicated for suspected pancreatitis, or mesenteric angiography to differentiate MPA from polyarteritis nodosa.

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Other Tests

Other tests may be ordered according to the specific organ system involved, as follows:

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Procedures

Biopsy

The following biopsies may be useful:

The results of a retrospective study suggest muscle biopsy may be helpful for the diagnosis of systemic vasculitides even in the absence of myalgias or creatine phosphokinase (CPK) elevation. [22]

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Histologic Findings

Pathologically, microscopic polyangiitis (MPA) may cause necrotizing arteritis that is histologically identical to that caused by polyarteritis nodosa.

According to the Chapel Hill consensus conference on the classification of small vessel vasculitis, polyarteritis nodosa and MPA are distinguished pathologically by the absence of vasculitis in vessels other than arteries in patients with polyarteritis nodosa and the presence of vasculitis in vessels smaller than arteries, such as arterioles, venules, and capillaries, in patients with MPA.

Because of sparing of muscular and larger vessels in MPA, macroscopic infarcts similar to those seen in polyarteritis nodosa are uncommon. Histologically, segmental fibrinoid necrosis of the media may be present, but in some, the change is limited to infiltration with neutrophils, which become fragmented as they follow the vessel wall (leukocytoclasia). The term leukocytoclastic angiitis is given to such lesions, most commonly found in postcapillary venules.

Immunoglobulins and complement components may be present in the vascular lesions of the skin. The paucity of immunoglobulin is demonstrable using immunofluorescence microscopy (ie, pauci-immune injury).

The glomerulonephritis in MPA is characterized by focal necrosis, crescent formation, and the absence or paucity of immunoglobulin deposits. Pulmonary manifestation is in the form of pulmonary alveolar capillaritis. Biopsy of the muscle and sural nerve may reveal necrotizing vasculitis in small and medium vessels.

Histopathology of alveolar hemorrhage in alveolar

Histopathology of alveolar hemorrhage in alveolar capillaritis.

Crescentic glomerulonephritis.

Crescentic glomerulonephritis.

Focal segmental glomerulonephritis.

Focal segmental glomerulonephritis.

Histopathology of leukocytoclastic angiitis.

Histopathology of leukocytoclastic angiitis.

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Author

Coauthor(s)

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Bryan L Martin, DO Associate Dean for Graduate Medical Education, Designated Institutional Official, Associate Medical Director, Director, Allergy Immunology Program, Professor of Medicine and Pediatrics, Ohio State University College of Medicine

Bryan L Martin, DO is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Allergy, Asthma and Immunology, American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Osteopathic Association

Disclosure: Nothing to disclose.