Evidence map›Paper›PMID 40930823›Full record

ArticleInternal medicine (Tokyo, Japan)2026

Vanishing Bile Duct Syndrome Caused by a Treatment Regimen Including Avacopan for Microscopic Polyangiitis.

Mako Hishinuma, Midori Hasegawa, Shun Minatoguchi, Ryosuke Umeda, Shigehisa Koide, Hiroki Hayashi, Yukio Yuzawa, Sachiko Minamiguchi, Naotake Tsuboi

Abstract readCase Reports
In one paragraph

Article in Internal medicine (Tokyo, Japan), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Article
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Mako HishinumaDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Midori HasegawaFaculty of Nursing, Fujita Health University School of Health Sciences, Department of Nephrology, Fujita Health University Hospital, Japan.
Shun MinatoguchiDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Ryosuke UmedaDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Shigehisa KoideDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Hiroki HayashiDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Yukio YuzawaDepartment of Nephrology, Fujita Health University School of Medicine, Japan.
Sachiko MinamiguchiDepartment of Diagnostic Pathology, Fujita Health University School of Medicine, Japan.
Naotake TsuboiDepartment of Nephrology, Fujita Health University School of Medicine, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

An 81-year-old man was treated with prednisolone, avacopan, and rituximab for microscopic polyangiitis and sulfamethoxazole/trimethoprim (SMX/TMP) and vonoprazan for prophylaxis. The liver enzyme levels were elevated 42 days after avacopan administration. Avacopan, SMX/TMP, and vonoprazan treatment were discontinued. A liver biopsy revealed vanishing bile duct syndrome. The patient was subsequently treated with ursodeoxycholic acid and glucocorticoid. Although vasculitis remained in remission, the patient ultimately died. Autopsy revealed persistent bile ductopenia and progressive liver cell injury confirmed by cytokeratin 7 positivity, severe cholestasis, and portal fibrosis. Further studies are required to elucidate associated mechanisms and risk factors.

Indexed as

Bile Duct DiseasesMicroscopic PolyangiitisAged, 80 and overFatal OutcomeGlycineHumansMalePrednisoloneRituximabSulfonamidesSyndromeTrimethoprim, Sulfamethoxazole Drug CombinationGlycinePrednisoloneRituximabsivelestatSulfonamidesTrimethoprim, Sulfamethoxazole Drug Combinationavacopanliver injurymicroscopy polyangiitis

Identifiers

PMID40930823
PMCPMC13106780

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.