Granulomatosis with polyangiitis (renal manifestations)

Last revised by Yahya Baba on 19 Feb 2023

The renal manifestations of granulomatosis with polyangiitis (GPA) are occult on imaging, especially when compared to the pulmonary changes. 

For a general discussion of the condition, please refer to the main article on granulomatosis with polyangiitis (GPA). For other organ-specific radiographic features, please refer to individual articles:

Granulomatosis with polyangiitis (previously known as Wegener granulomatosis), is a multi-system systemic necrotizing non-caseating granulomatous vasculitis affecting small to medium-sized arteries, capillaries and veins.

Approximately half of GPA patients have kidney disease at presentation. 

Three patterns of appearance4.

  • solitary-type (62%, 13/21)

  • multiple bilateral masses (28.5%, 6/21)

  • multiple unilateral masses (9.5%, 2/21)

Reduced renal function, proteinuria and hematuria. 

GPA affects the kidneys with the development of necrotizing glomerulonephritis in ~60% (range 39-80%) of patients. 

Contrast-enhanced CT findings4.

  • hypovascular mass (100%, 15/15)

  • unclear margins ( 93%, 14/15)

  • opacity of peri-renal fat ( 20%, 3/15)

  • enlargement of the para-aortic lymph nodes (7%, 1/15)

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