Vasculitis describes a group of inflammatory disorders with variable presentations and implications for the patient concerned. In the renal unit, vasculitis most commonly means rapidly progressive glomerulonephritis, an aggressive disease that invariably leads to renal failure unless effective treatment can be started promptly. However, vasculitis is typically a systemic disorder. The presence of inflammatory disease in other parts of the body, such as, the skin or eye may lead to a delay in diagnosis and referral to another department. The last 20 years has seen major advances in the diagnosis and classification of vasculitis and this has been of direct benefit to patients as medical staff have a better understanding of the condition. Vasculitis is usually treatable with the combination of steroid and immune suppressive drugs, but treatment has to be prolonged, is associated with many side-effects and patients do not always recover their pre-morbid state of health.

With the development of newer therapies for transplantation and other inflammatory diseases the treatment of vasculitis is changing too. Alternative immune suppressives and therapeutic monoclonal antibodies has provided increased choice for the treating physician especially when standard regimens are not tolerated or ineffective. Much current research effort is focused on testing these newer agents in order to improve patients’ outcomes but also to use targeted drugs to explore the mechanisms underlying the disease.

With the development of large clinical trial databases during the 1990s longer term follow-up studies are now feasible in vasculitis. Preliminary results have revealed increased mortality and increased cardiovascular risk but there is no clear indication of an increase in malignancy. It will be important to determine how current therapeutic strategies influence longer term outcomes and whether additional interventions are required to reduce these increased risks.