A patient Complains of hematuria. Renal biopsy demonstrates a focal necrotizing glomerulonephritis with crescent formation. He also complains of decreased sensation in hand and feet .What next best investigation should be done to diagnose the condition?: (A) MIF, (B) HbsAg, (C) RA factor, (D) ANCA
Answer is D. Patient is suffering from vasculitis due to which he is manifesting symptoms of haematuria , periphral neuropathy and glomerulopnephritis ,and next investigation should be ANCA to narrow down specific cause. Antineutrophil cytoplasmic antibodies (ANCA) The antibodies are of two types, anti-proteinase 3 (PR3) or anti-myeloperoxidase (MPO) ANCA are produced with the help of T cells and activate leukocytes and monocytes, which together damage the walls of small vessels. ANCA antibodies are directed against cell constituents because of which circulating immune complexes are not present. c - ANCA p- ANCA Anti-proteinase 3 Anti-myeloperoxidase Granulomatosis with polyangiitis (Wegener granulomatosis) Microscopic polyangiitis and Churg-Strauss syndrome Cytoplasmic staining Perinuclear staining FIG: 1. C-ANCA, 2. P-ANCA-staining patterns on alcohol-fixed human neutrophils.