Klinische Wochenschrift

, Volume 69, Issue 13, pp 536–551 | Cite as

New horizons in renal vasculitis

  • J. S. Cameron


After a long period during which few new data on the vasculitides emerged, the past decade has seen a real explosion of data on the subject. This began with basic clinical descriptions and the deliniation of long term outcome as survival improved to a major extent under the influence of improved treatment regimes. In parallel, better understanding of the immunopathology has emerged. Of particular interest have been descriptions of autoantibody systems in vasculitis which seem to be specific to vasculitis and therefore diagnostically useful: the antineutrophil cytoplasmic antibodies (ANCA). Whether or not these are pathogenetically significant as well as useful remains a matter for debate. In parallel, anti endothelial cell antibodies have been described, but their role (if any), in pathogenesis remains equally obscure. There are some suggestions that vasculitis is becoming more common, but increased awareness and the availability of ANCA have undoubtedly increased awareness of the subject.

Key words

Vasculitis Polyarteritis Wegener's granuloma Anti-neutrophil Cytoplasmic antibody (ANCA) Schonlein-Henoch purpura Glomerulonephritis 



anti endothelial cell antibodies


American College of Rheumatology


anti neutophil cytoplasmic antibodies


deoxyribonucleic acid


erythrocyte sedimentation rate


human leukocyte antigen


non steroidal anti-inflammatory drug


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kussmaul A, Maier K (1866) Über eine bisher nicht beschriebene eigentümliche Arterien-Erkrankung (Periarteritis nodosa), die mit Morbus Brightii and rapid fortschreitender allgemeiner Muskellähmung einhergeht. Dtsch Arch Klin Med 1:484–518Google Scholar
  2. 2.
    Rokitansky K (1852) Über einige der wichtigen Krankheiten der Arterien. Denkschrift Kais Akad der Wissenschaft 4:49Google Scholar
  3. 3.
    Wegener F (1936) Über generalisierte, septische Gefäßerkrankungen. Verh Dtsch Ges Pathol 29:202–210Google Scholar
  4. 3a.
    Wegener F (1939) Über eine eigenartige rhinogene Granulomatose mit besonderer Beteiligung des Arteriensystems und der Nieren. Beitrag Pathol 102:36–68Google Scholar
  5. 4.
    Klinger H (1931) Grenzformen der Periarteritis nodosa. Z Pathol, Frankfurt 42:455–480Google Scholar
  6. 5.
    Cameron JS (1988) Historical review. In: Cameron JS, Glassock RJ (eds) The nephrotic syndrome. Marcel Dekker, New York, pp 3–56Google Scholar
  7. 6.
    Heberden W (1801) Purpura maculae. In: Commentaries on the history and cure of diseases. Payne, London, pp 395–396Google Scholar
  8. 7.
    Willan R (1808) Exanthemae purpura uriticans. In: Cutageous disease. Johnson, London, pp 461–463Google Scholar
  9. 8.
    Johnson G (1852) On diseases of the kidney. Parker, London, p 152Google Scholar
  10. 9.
    Truong L, Kopelman RG, Williams GS, Pirani CL (1985) Temporal arteritis and renal disease. Case report and review of the literature. Am J Med 78:171–175Google Scholar
  11. 10.
    Salcedo JR, Greenberg GL, Kapur S (1988) Renal histology of mucocutaneous lymph node syndrome (Kawasaki disease). Clin Nephrol 29:347–351Google Scholar
  12. 11.
    Yoshimura M, Kida H, Saito H, Yokoyama H, Tomosugi N, Abe T, Hattori N (1985) Peculiar glomerular lesions in Takayasu's arteritis. Clin Nephrol 24:120–127Google Scholar
  13. 12.
    Gocke DJ, Hsu K, Morgan C, Bombardieri S, Lockshin M, Christian CL (1970) Association between polyarteritis and Australia antigen. Lancet 2:1149–1153Google Scholar
  14. 13.
    Brentjens JR, Andres GA (1985) Immunopathogenesis of renal vasculitis. Sem Nephrol 5:3–14Google Scholar
  15. 14.
    Bodaghi E, Kheradpir KMH, Maddah M (1987) Vasculitis in acute poststreptococcal glomerulonephritis. Int J Pediatr Nephrol 8:69–74Google Scholar
  16. 15.
    Ingelfinger JR, McCluskey RT, Grupe WE (1977) Necrotising arteritis in acute post-streptococcal glomerulonephritis. J Pediatr 91:228–232Google Scholar
  17. 16.
    Serra A, Cameron JS, Turner DR, Hartley B, Ogg CS, Neild GH, Williams DG, Taube D, Brown CB, Hicks JA (1984) Vasculitis affecting the kidney: presentation, histopathology and long-term outcome. QJ Med:181–207Google Scholar
  18. 17.
    Serra A, Cameron JS (1985) Clinical and pathologic aspects of renal vasculitis. Sem Nephrol 5:15–33Google Scholar
  19. 18.
    Weiss MA, Crissman JD (1985) Segmental necrotizing glomerulonephritis: diagostic, prognostic and theraputic significance. Am J Kidney Dis 6:199–211Google Scholar
  20. 19.
    Velosa JA (1987) Idiopathic crescentic glomerulonephritis or systemic vasculitis? Mayo Clin Proc 62:145–147Google Scholar
  21. 20.
    Croker BP, Lee T, Gunnells JC (1987) Clinical and pathologic features of polyarteritis and its renal-limited variant: primary crescentic and necrotizing glomerulonephritis. Hum Pathol 18:38–44Google Scholar
  22. 20a.
    Woodworth TG, Abuelo JG, Austin HA III, Esparza A (1987) Severe glomerulonephritis with late emergence of classic Wegener's granulomatosis. Report of 4 cases and review of the literature. Medicine (Baltimore) 66:181–191Google Scholar
  23. 21.
    Cameron JS (1979) The nephritis of Henoch Schoenlein purpura: current problems. In: Kincaid-Smith P, D'Apice AJF, Atkins RC (eds) Progress in glomerulonephritis. Wiley, New York, pp 283–309Google Scholar
  24. 22.
    Habib R, Cameron JS (1982) Henoch Schoenlein purpura. In: Bacon PA, Hadler NM, (eds) The kidney in rheumatic disease. Butterworths, London, pp 178–201Google Scholar
  25. 23.
    Leavitt RY and 15 others (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener's granulomatosis. Arthr Rheum 33:1101–1107Google Scholar
  26. 24.
    Davson J, Ball J, Platt R (1948) The kidney in periarteritis nodosa. Q J Med 17:175–202Google Scholar
  27. 25.
    Lightwood RW and 13 others (1990) The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthr Rheum 33:1088–1093Google Scholar
  28. 26.
    Mills JA and 15 others (1990) The American College of Rheumatology 1990 criteria for the classification of Henoch Schoenlein purpura. Arthr Rheum 33:1114–1121Google Scholar
  29. 27.
    van der Woude FJ, van Es LA (1991) Pathogenesis of angiitis. In: Cameron JS et al. (eds) Oxford textbook of clinical nephrology. Oxford University Press, London (in press)Google Scholar
  30. 28.
    Kallenberg CGM, Cohen Tervaert JW, van der Woude FJ, Goldschmeding R, von dem Borne AEG Kr, Weening JJ (1991) Autoimmunity to lysosomal enzymes: new clues to vasculitis and glomerulonephritis? Immunol Today 1991 12:61–64Google Scholar
  31. 29.
    Nast CC, Ward HJ, Koyle MA, Cohen AH (1990) Recurrent Henoch Schoenlein purpura following renal transplantation. Am J Kidney Dis 9:39–43Google Scholar
  32. 30.
    Hasegawa A, Kawamura T, Ito O, Hasegawa O, Ogawa O, Honda M, Ohara T, Hajikano H (1989) Fate of renal grafts with recurrent Henoch-Schoenlein purpura nephritis in children. Transpl Proc 21:2130–2133Google Scholar
  33. 31.
    D'Agati V, Chander P, Nash M, Mancilla-Jimenez R (1986) Idiopathic microscopic polyarteritis nodosa: ultrastructural observations on the renal vascular and glomerular lesions. Am J Kidney Dis 7:95–110Google Scholar
  34. 32.
    Ronco P, Verroust P, Mignon F, Kourilsky O, Vanhille Ph, Meyrier A, Mery JPh, Morel-Maroger L (1983) Immunopathological studies of polyarteritis nodosa and Wegener's granulomatosis. A report of 43 patients with 51 renal biopsies. Q J Med 52:212–223Google Scholar
  35. 33.
    Leib ES, Hibrami H, Chia D, Blaker RG, Barnett EV (1981) Correlation of disease activity in systemic necrotizing vasculitis with immune complexes. J Rheumatol 8:258–265Google Scholar
  36. 34.
    Greer JM, Longley S, Edwards NL, Elfenbein GJ, Panush RS (1988) Vasculitis associated with malignancy. Experience with 13 patients and literature review. Medicine (Baltimore) 67:220–230Google Scholar
  37. 35.
    Van Der Woude FJ, Rasmussen N, Lobatto S, Wiik A, Permin H, van Es L, van der Giessen M, van der Hem GK, The TH (1985) Autoantibodies against neutrophils and monocytes: tool for diagnosis and marker for disease activity in Wegener's granulomatosis. Lancet 1:425–430Google Scholar
  38. 36.
    Davies DJ, Moran JE, Niall JF, Ryan GB (1982) Segmental necrotising glomerulonephritis with antineutrophil antibody; possible arbovirus aetiology? Br Med J 285:606Google Scholar
  39. 37.
    Hall JB, Wadham B McN, Wood CJ, Ashton V, Adam WR (1984) Vasculitis and glomerulonephritis; a subgroup with an antineutrophil cytoplasmic antibody. Aust NZ J Med 14:277–278Google Scholar
  40. 38.
    Lancet editorial (1991) Antibodies to enothelial cells. Lancet 337:649–650Google Scholar
  41. 39.
    Brasile L, Kremer JM, Clarke JL (1989) Identification of an autoantibody to vascular enothelial cell-specific antigens in patients with systemic vasculitis. Am J Med 87:74–80Google Scholar
  42. 40.
    Ferraro G, Meroni PL, Tincani A, Sinico A, Barcellini W, Radice A, Gregorini G, Froldi M, Borghii MO, Balestrieri G (1990) Anti endothelial cell antibodies in patients with Wegener's granulomatosis and micropolyarteritis. Clin Exp Immunol 79:47–53Google Scholar
  43. 41.
    Frampton G, Jayne DRW, Perry GJ, Lockwood CM, Cameron JS (1990) Autoantibodies to endothelial cells and neutrophil cytoplasmic antigens in systemic vasculitis. Clin Exp Immunol 82:227–232Google Scholar
  44. 42.
    Savage COS, Pottinger B, Gaskin G, Lockwood CM, Pusey CD, Pearson J (1991) Vascular damage in Wegener's granulomatosis: presence of anti-endothelial cell antibodies and their relation to anti-neutrophil cytoplasmic antibodies. Clin Exp Immunol (in press)Google Scholar
  45. 42a.
    Perry GJ, Cameron JS, Frampton G (1990) Preliminary characterisation of endothelial cell autoantigens in glomerulonephritis. Nephrol Dialysis Transpl 5:683 (abstract)Google Scholar
  46. 43.
    Savage COS, Winearls CG, Jones S, Marshall PD, Lockwood CM (1987) Prospective study of radioimmunoassay for antibodies against neutrophil cytoplasm in diagnosis of systemic vasculitis. Lancet 1:1389–1393Google Scholar
  47. 44.
    Parlevliet KJ, Henzen-Longmans SC, Oe PL, Bronsveld W, Balm AJM, Donker AJM (1988) Antibodies to components of neutrophil cytoplasm: a new diagnostic tool in patients with Wegener's granulomatosis and systemic vasculitis. Q J Med 66:55–63Google Scholar
  48. 45.
    Nölle B, Specks U, Ludemann J, Rohrbach MS, DeRemee RA, Gross WL (1989) Anticytoplasmic autoantibodies: their immunodiagnostic value in Wegener granulomatosis. Ann Int Med 111:28–40Google Scholar
  49. 46.
    Venning MC, Quinn A, Broomhead V, Bird AG (1990) Antibodies directed against neutrophils (C-ANCA and P-ANCA) are of distinct diagnostic value in systemic vasculitis. Q J Med 77:1287–1296Google Scholar
  50. 47.
    Jayne DRW, Marshall PD, Jones SJ, Lockwood CM (1990) Autoantibodies to GBM and neutrophil cytoplasm in rapidly progressive glomerulonephritis. Kidney Int 37:965–970Google Scholar
  51. 48.
    Jennette JC, Falk RJ (1990) Antineutrophil cytoplasmic autoantibodies and associated diseases: a review. Am J Kidney Dis 15:517–529Google Scholar
  52. 49.
    Efthamiou J, Spickett G, Lane D, Thompson A (1991) Antineutrophil cytoplasmic antibodies, cystic fibrosis, and infection. Lancet 337:1037–1038Google Scholar
  53. 50.
    Goldschmeding R, van der Schoot, CE, ten Bokkel Hack, D, Hack CE, van den Ende ME, Kallenberg CGM, von dem Borne AEGKr (1989) Wegener's granulomatosis autoantibodies identify a novel diisopropylfluorophosphate — binding protein in the lysosome of normal human neutrophils. J Clin Invest 84:1577–1587Google Scholar
  54. 51.
    Cohen Tervaert JW, Godschmeding R, Elema JD, Limburg PC, van der Giessen M, Huitema MG, Koolen MI, Hene R, The TH, van der Hem GK, von dem Borne AEGKr, Kallenberg CGM (1990) Association of autoantibodies to myeloperoxidase with different forms of vasculitis. Arthr Rheum 33:1264–1271Google Scholar
  55. 52.
    Falk RJ, Terrell R, Charles LA, Jennette CJ (1990) Antineutrophil cytoplasmic antibodies induce neutrophils to degranulate and produce oxygen radicals. Proc Natl Acad Sci USA 87:4115–4119Google Scholar
  56. 53.
    Czernok E, Ludemann J, Gross WL, Bainton DF (1990) Clin Rheumatol 9:107 cited in ref. 28Google Scholar
  57. 54.
    Savage COS, Pottinger BE, Pearson JD (1991) Antibodies to myeloperoxidase (MPO) and proteinase 3 (P3) stimulate neutrophil cytotoxicity towards endothelial cells. (abstract) Nephrol Dialysis Transpl 6:(in press)Google Scholar
  58. 55.
    Ewert B, Jennette JC, Falk R (1990) Anti neutrophil cytoplasmic antibodies (ANCA) stimulate cytokine-primed neutrophils to damage endothelial cells. (abstract) J Am Soc Nephrol 1:520Google Scholar
  59. 56.
    Varagunam M, Adu D, Taylor CM, Michael J, Neuberger J, Richards N (1991) Myeloperoxidase (MPO) — endothelium — anti MPO interaction in vasculitis. (abstract) Nephrol Dialysis Transpl (in press)Google Scholar
  60. 57.
    Brouwer E, Cohen Tervaert JW, Weening JJ, Kallenberg CGM (1990) Immunohistolopathology of renal biopsies in Wegener's granulomatosis (WG): clues for its pathogenesis? (abstract) J Am Soc Nephrol 1:73Google Scholar
  61. 58.
    Abbott F, Jones S, Lockwood CM, Rees AJ (1989) Autoantibodies to glomerular antigens in patients with Wegener's granulomatosis. Nephrol Dialysis Transpl 4:1–8Google Scholar
  62. 59.
    Knight JF, Harada T, Thomas MAB, Frampton G, Savage COS, Chantler C, Williams DG (1988) IgA rheumatoid factor and other autoantibodies in acute Henoch-Schoenlein purpura. Contr Nephrol 67:117–120Google Scholar
  63. 60.
    Baldree LA, Jennette JC, Falk RJ, Ault BH, Wyatt RJ (1989 — check vol) Lack of anti-neutrophil cytoplasmic autoantibody (ANCA) in children with Henoch Schoenlein purpra (HSP). (abstract) Pediatr Res 29:338AGoogle Scholar
  64. 61.
    van der Wall Bakke AWL (1988) IgA anti-cytoplasmic antibodies in IgA nephropathy and other diseases. In: Workshop on induction and regulation of immunologically — mediated nephritis. Joint meeting of the British Society of Immunology and the French Society of Immunology, Paris April 9thGoogle Scholar
  65. 62.
    Ronda N, Esnault VLM, Lockwood CM (1991) IgA antineutrophil cytoplasm antibodies (ANCA) in IgA related renal disease. (abstract) Nephrol Dialysis Transpl 6: (in press)Google Scholar
  66. 63.
    Yoshikawa Y, Watanabe T (1984) Granulomatous glomerulonephritis in Wegener's granulomatosis. Virchow's Arch (Pathol Anat) 402:361–372Google Scholar
  67. 64.
    Mignon F, Mery J-P, Morel-Maroger L, Mougenot B, Ronco P, Roland J (1984) Granulomatous tubulointerstitial nephritis. Adv Nephrol 13:219–245Google Scholar
  68. 65.
    Akikusa B, Irabu N, Matsumura R, Tsuchida H (1990) Tubulointerstitial changes in systemic vasculitic disorders: a quantitiative study of 18 cases. Am J Kidney Dis 16:481–486Google Scholar
  69. 66.
    Coelho das Neves F, Hartley B, Cameron JS, Leaker B, Cambridge J, Neild GH (1991) Interstitial, intraglomerular and crescentic cells — in renal vasculitis. Contr Nephrol (in press)Google Scholar
  70. 67.
    Grau GE, Roux-Lombard P, Gysler C, Lambert PH, Dayer JM, Guillevin L (1989) Serum cytokine changes in systemic vasculitis. Immunology 68:196–198Google Scholar
  71. 68.
    Nolasco FEB, Cameron JS, Hartley B, Coelno A, Hildreth G, Reuben R (1987) Intraglomerular T cells and monocytes in nephritis: study with monoclonal antibodies. Kidney Int 31:1160–1167Google Scholar
  72. 69.
    Van der Woude FJ, van Es LA, Daha MR (1990) The role of the C-ANCA antigen in the pathogenesis of Wegener's granulomatosis. A hypothesis based on both humoral and cellular mechanisms. Neth J Med 36:169–171Google Scholar
  73. 70.
    Moyer CF, Reinish CL (1984) The role of vascular cells in experimental hypersensitivity angiitis. I. The initiation of delayed-type hypersensitivity. Am J Pathol 117:380–390Google Scholar
  74. 71.
    Hart MN, Tassell SK, Sadewasser KL, Schelper RL, Moore SA (1985) Autoimmune vasculitis resulting from in vitro immunization of lymphocytes to smooth muscle. Am J Pathol 119:448–455Google Scholar
  75. 72.
    Reimold EW, Weinberg AG, Finck CW, Battles ND (1976) Polyarteritis in children. Am J Dis Child 130:534–541Google Scholar
  76. 73.
    Blau EB, Morris EF, Yunis EJ (1977) Polyarteritis nodosa in older children. Pediatrics 60:227–234Google Scholar
  77. 74.
    Orlowski JP, Clough JD, Dyment PG (1978) Wegener's granulomatosis in the pediatric age group. Pediatrics 61:83–90Google Scholar
  78. 75.
    Hall SL, Miller LC, Duggan E, Mauer SM, Beatty EC, Hellerstein S (1985) Wegener granulomatosis in pediatric patients. J Pediatr 106:739–744Google Scholar
  79. 76.
    Spencer SJ, Burns A, Gaskin G, Pusey C, Rees AJ (1991) Influence of HLA class II genes on susceptibility to vasculitis. Nephrol Dialysis Transpl (in press) (abstract)Google Scholar
  80. 77.
    Fuiano G, Cameron JS, Raftery M, Hartley BH, Gwyn Williams D, Ogg CS (1988) Improved prognosis of renal microscopic polyarteritis in recent years. Nephrol Dialysis Transpl 3:383–391Google Scholar
  81. 78.
    Clutterbuck E, Evans DJ, Pusey CD (1990) Renal involvement of the Churg Strauss syndrome.Nephrol Dialysis Transpl 5:161–167Google Scholar
  82. 79.
    Pusey C, Rees AJ, Evans D, Peters DK, Lockwood CM (1991) A randomized controlled trial of plasma exchange in focal necrotizing glomerulonephritis without anti-GBM antibodies. Kidney Int (in press)Google Scholar
  83. 80.
    Balow JE (1985) Renal vasculitis. (Nephrology forum). Kidney Int 27:954–964Google Scholar
  84. 81.
    Hoffman GS, Leavitt RY, Fleischer TA (1990) Treatment of Wegener's granulomatosis with intermittent high dose intravenous cyclophosphamide. Am J Med 89:403–410Google Scholar
  85. 82.
    Cupps TR (1990) Cyclophosphamide: to pulse or not to pulse? Am J Med 89:399–402Google Scholar
  86. 83.
    Borleffs JCC, van der Zwan JC (1990) Cyclosporin in Wegener's granulomatosis with renal failure. (letter) Br Med J 287:568Google Scholar
  87. 84.
    Clarke AE, Bitton A, Eappen R, Danoff DS, Easdaile JM (1990) Treatment of Wegener's granulomatosis after renal transplantation: is cyclosporine the preferred treatment? Transplantation 50:1047–1051Google Scholar
  88. 85.
    Bolton WK 1984 Use of pulse methylprednisolone in primary and multisystem glomerular diseases. In: Robinson RR (ed) Nephrology. Springer, New York, pp 1464–1473Google Scholar
  89. 86.
    Stilwell TJ, Benson RC, DeRemee RA, McDonald TJ, Weiland LH (1988) Cyclophosphamide-induced bladder toxicity in Wegener's granulomatosis. Athritis Rheum 31:465–470Google Scholar
  90. 87.
    Boltus JAM, Boersma JW, Hartman AP, Vandenbroucke JP (1983) The occurrence of malignancies in patients with rheumatoid arthritis treated with cyclophosphamide. Ann Rheum Dis 42:368–373Google Scholar
  91. 88.
    Mathieson PW, Cobbold SP, Hale G, Clark MR, Oliviera DGB, Lockwood CM, Waldmann H (1990) Monoclonal antibody therapy in systemic vasculitis. New Engl J Med 323:250–254Google Scholar
  92. 89.
    Jayne DRW, Davies MJ, Fox CJV, Black CM, Lockwood CM (1991) Treatment of systemic vasculitis with pooled intravenous immunoglobulin. Lancet 337:1137–1139Google Scholar
  93. 90.
    Cohen-Tervaert JW, Huitema MG, Hené R, Sluiter WJ, The TH, can der Hem GK, Kallenberg CGM (1990) Prevention of relapses in Wegener's granulomatosis by treatment based on antineutrophil cytoplasmic antibody titres. Lancet 336:709–711Google Scholar
  94. 91.
    Gaskin G, Savage COS, Ryan JJ, Jones S, Lockwood CM, Pusey CD (1991) Anti neutrophil cytoplasmic antibodies and disease activity during followup of 70 patients with systemic vasculitis. Nephrol Dialysis Transpl 6: (in press)Google Scholar
  95. 92.
    Savage COS, Winearls CG, Evans DJ, Rees AJ, Lockwood CM (1985) Microscopic polyarteritis. Presentation, pathology and prognosis. Q J Med 56:467–484Google Scholar
  96. 93.
    Ten Berge IJM, Wilmink JM, Meyer CJLM, Surachno J, ten Veen KH, Balk TG, Schellenkens PTA (1985) Clinical and immunological follow-up of patients with severe renal disease in Wegener's granulomatosis. Am J Nephrol 5:21–29Google Scholar
  97. 94.
    Coward RA, Hamdy NAT, Shortland JS, Brown CB (1986) Renal micropolyarteritis: a treatable condition. Nephrol Dialysis Transpl 1:31–37Google Scholar
  98. 95.
    Adu D, Howie AJ, Scott DGI, Bacon PA, McGonigle RJS, Michael J (1987) Polyarteritis and the kidney. Q J Med 62:221–237Google Scholar
  99. 96.
    Andrassy K, Erb A, Koderisch J, Waldherr R, Ritz E (1991) Wegener's granulomatosis with renal involvement: patient survival and correlations between initial renal function, renal histology, therapy and renal outcome. Clin Nephrol 35:139–147Google Scholar
  100. 97.
    Gaskin G, Rees AJ (1991) Systemic vasculitis. In: Oxford textbook of clinical nephrology. Oxford University Press, London (in press)Google Scholar
  101. 98.
    Bradley JD, Brandt KD, Katz BP (1989) Infectious complications of cyclophosphamide treatment for vasculitis. Arthr Rheum 32:45–53Google Scholar
  102. 99.
    Neild GH (1991) Infectious complications in the management of systemic vasculitis and rapidly progressive glomerulonephritis. Cambridge (in press)Google Scholar
  103. 100.
    Curtis JJ, Diethelm AG, Herrera GA, Crowell WT, Whelchel JD (1983) Recurrence of Wegener's granulomatosis in a cadaver renal allograft. Transplantation 36:452–454Google Scholar
  104. 101.
    Andrews M, Edmunds M, Campbell A, Walls J, Feehally J (1990) Systemic vasculitis in the 1980s — is there an increasing incidence of Wegener's granulomatosis and microscopic polyarteritis? J Roy Coll Physcns Lond 24:284–288Google Scholar
  105. 102.
    Woodrow G, Cook JA, Brownjohn AM, Turney JH (1990) Is renal vasculitis increasing in incidence? (letter) Lancet 336:1583Google Scholar

Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • J. S. Cameron
    • 1
    • 2
  1. 1.United Medical and Dental Schools of Guy's and St Thomas's HospitalsLondonUK
  2. 2.Clinical Science LaboratoriesGuy's HospitalLondonUK

Personalised recommendations