Journal of Clinical Nephrology and Renal Care Merino et al. J Clin Nephrol Ren Care 2017, 3:024 DOI: 10.23937/2572-3286/1510024 Volume 3 | Issue 1 Open Access ISSN: 2572-3286 Citaton: Merino JL, Amézquita Y, López-Oliva MO, Prados MC, Fidalgo P, et al. (2017) Ant-Neutrophil Cytoplasmic Antbody (Anca)-Negatve Small Vessel Pulmonary Vasculits in a Chronic Hemodialysis Patent. J Clin Nephrol Ren Care 3:024. doi.org/10.23937/2572-3286/1510024 Received: February 20, 2017; Accepted: April 15, 2017; Published: April 17, 2017 Copyright: © 2017 Merino JL, et al. This is an open-access artcle distributed under the terms of the Creatve Commons Atributon License, which permits unrestricted use, distributon, and reproducton in any medium, provided the original author and source are credited. • Page 1 of 4 • Merino et al. J Clin Nephrol Ren Care 2017, 3:024 Ant-Neutrophil Cytoplasmic Antbody (Anca)-Negatve Small Vessel Pulmonary Vasculits in a Chronic Hemodialysis Patent Jose Luis Merino 1 *, Yésika Amézquita 2 , Maria Ovidia López-Oliva 3 , María Concepción Prados 4 , Pilar Fidalgo 5 and Vicente Paraíso 1 1 Nephrology Department, Hospital Universitario del Henares, Coslada, Spain 2 Nephrology Department, Hospital Universitario Infanta Sofa, Spain 3 Nephrology Department, Hospital Universitario La Paz, Spain 4 Pneumology Department, Hospital Universitario La Paz, Spain 5 Internal Medicine Department, Hospital Universitario del Henares, Spain *Corresponding author: Dr. Jose L Merino, Nephrology Department, Hospital Universitario del Henares, Avenida Marie Curie S/N, PC: 28822, Coslada, Madrid, Spain, E-mail: jluis.merino@salud.madrid.org Abstract The development of vasculitis in renal replacement therapy is rare due to the immunological condition of these patients. Its diagnosis is often complex and invasive tests are usually required. A multidisciplinary approach is mandatory and a broad study (including lung biopsy) is necessary for its diagnosis which is crucial to support the necessity of immunosuppressive therapy in this kind of patients. We report a case of a hemodialysis patient with anti-neutrophil cytoplasmic antibody (ANCA)-negative small vessel pulmonary vasculitis de novo diagnosed two years after starting dialysis. Keywords Lung biopsy, Vasculitis, Steroid, Hemodialysis CAse RePORt Introducton Currently vasculits is a minor cause of end-stage renal disease [1]. Once on renal replacement therapy (RRT), relapse of this process is uncommon due to the immunosuppressive status of these patents [2]. Symptoms are usually associated with lung disease and although morbidity and mortality have improved in recent years they stll remain high. Its diagnosis is ofen complex and invasive tests are usually required [3,4]. Lung biopsy (LB) is not a risk free technique but it may be necessary for the diagnosis of this entty when other studies are not conclusive [5]. We report a case of a hemodialysis patent with ant-neutrophil cytoplasmic antbody (ANCA)-negatve small vessel vasculits de novo diagnosed by LB. Case Report A 29-year-old woman with chronic kidney disease secondary to chronic intersttal nephropathy diagnosed by a kidney biopsy, in RRT with hemodialysis for 30 months using a right jugular tunneled catheter, began tacrolimus and prednisone treatment one week before hospital admission for a scheduled related kidney donor transplant. On admission, a simple chest X-ray showed a radiopaque image in the lower lobe of the lef lung, confrmed by chest computerized tomography (CT) (Figure 1). An expanded study and empirical antbiotc treatment was decided in the absence of respiratory symptoms. Mycoplasma pneumoniae MIg was positve and Candida sp was detected in induced sputum afer reviewing fuconazole and specifc antbiotc treatment (the patent was discharged one month later). The kidney transplant (KT) was cancelled. CT was repeated six months later when the patent was asymptomatc. A reducton of the pseudo nodular consolidaton in the posterior basal segment of the inferior lobe of the lef lung (LIL) was observed, but with the presence of cavitated areas inside the consolidaton. In additon, new ground-glass appearance injuries were detected in the right superior