WEGENERS GRANULOMATOSIS - A METAANALYSIS OF 349 LITERARY CASE-REPORTS

We report the results of a meta-analysis of 349 patients with Wegener' s granulomatosis (WG) that were described in the literature from 1979 onward. We describe the patients in terms of diagnosis (granulomas pre sent or absent in biopsy samples from various organs, results of the a nti-neutrophil cytoplasmic antibody (ANCA) test) and of the clinical i mpact of renal involvement. Furthermore, we report the incidence of hi stopathologic lesions that were found in 134 renal biopsy samples. Bef ore and after the development of the ANCA test, the percentage of pati ents in whom WG was diagnosed with histologically proven granulomas is the same. However, after 1987 the diagnosis of the group without gran ulomas is frequently supported by a positive ANCA test result. For the entire group we found that patients without renal involvement (N = 82 ) were reported to have lower erythrocyte sedimentation rate (ESR), lo wer white blood cell count (WBC), less anemia, less hypertension, less occurrence of joint symptoms, and less multi-organ involvement than p atients with renal involvement (N = 267). The most frequently reported lesion in the renal biopsy samples was extracapillary proliferation ( 70%), followed by fibrinoid necrosis of the glomerular tuft (54%). Ren al granulomas were reported in only 7 biopsy samples.