Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease
Introduction: A significant number of patients with antineutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2) despite advances in...
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Elsevier
2024-05-01
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| Series: | Kidney International Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924015213 |
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| author | Marta Casal Moura Dalia Zubidat Marc Patricio Liebana Sanjeev Sethi Maria Jose Soler Ladan Zand Fernanda G. dos Santos Luca Nardelli Juan Leon-Roman Ciria Sousa Kenneth J. Warrington Ulrich Specks Fernando C. Fervenza |
| author_facet | Marta Casal Moura Dalia Zubidat Marc Patricio Liebana Sanjeev Sethi Maria Jose Soler Ladan Zand Fernanda G. dos Santos Luca Nardelli Juan Leon-Roman Ciria Sousa Kenneth J. Warrington Ulrich Specks Fernando C. Fervenza |
| author_sort | Marta Casal Moura |
| collection | DOAJ |
| description | Introduction: A significant number of patients with antineutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2) despite advances in remission-induction treatment. Methods: This is a retrospective cohort study on myeloperoxidase (MPO)-ANCA or proteinase 3 (PR3)-ANCA positive patients with AAV (microscopic polyangiitis, MPA; or granulomatosis with polyangiitis, GPA) and eGFR <15 ml/min per 1.73 m2 or ESKD at presentation. Renal recovery, dialysis discontinuation, and persistence of ESKD after standard remission-induction, with or without the use of plasma exchange (PLEX) were analyzed. Results: We analyzed 166 patients with biopsy-proven active AAV-GN and eGFR <15 ml/min per 1.73 m2 at the time of diagnosis. Patients received glucocorticoids with cyclophosphamide (CYC) (n = 84) or with rituximab (RTX) (n = 72) for remission-induction, and 49 received PLEX. The predictors of renal recovery were erythrocyte sedimentation rate, serum creatinine (SCr) at diagnosis, and minimal or mild chronicity changes. We further analyzed 71 patients who started dialysis with or without PLEX within 4 weeks of AAV-GN diagnosis. The predictors of dialysis discontinuation were minimal chronicity changes in kidney biopsy at diagnosis (odds ratio = 6.138; 95% confidence interval [CI]: 1.389–27.118; P = 0.017). Predictors of persistence of ESKD within 12 months included higher SCr at diagnosis (incidence rate ratio [IRR] = 1.086; 95% CI: 1.005–1.173; P = 0.037), and moderate (IRR = 3.797; 95% CI: 1.090–13.225; P = 0.036), or severe chronicity changes in kidney biopsy (IRR = 5.883; 95% CI: 1.542–22.439; P =0.009). Conclusion: In our cohort, kidney recovery, dialysis discontinuation, and persistence of ESKD in patients with AAV-GN and eGFR <15 ml/min per 1.73 m2 depended on SCr and histologic findings on kidney biopsies at the time of diagnosis and was not affected by the addition of PLEX. |
| format | Article |
| id | doaj-art-9f9b1508cd8e4e06a1418df87b834372 |
| institution | OA Journals |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
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| series | Kidney International Reports |
| spelling | doaj-art-9f9b1508cd8e4e06a1418df87b8343722025-08-20T02:06:03ZengElsevierKidney International Reports2468-02492024-05-01951284129710.1016/j.ekir.2024.02.1431Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney DiseaseMarta Casal Moura0Dalia Zubidat1Marc Patricio Liebana2Sanjeev Sethi3Maria Jose Soler4Ladan Zand5Fernanda G. dos Santos6Luca Nardelli7Juan Leon-Roman8Ciria Sousa9Kenneth J. Warrington10Ulrich Specks11Fernando C. Fervenza12Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USAServicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, SpainDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USAServicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, SpainDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Servicio de Nefrologia, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, SpainDivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USADivision of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA; Correspondence: Fernando C. Fervenza, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55901. Phone: 507-266-7961; Fax: 507-266-7892.Introduction: A significant number of patients with antineutrophil cytoplasmic antibodies (ANCA)- associated vasculitis (AAV) with glomerulonephritis (AAV-GN) still progress to end-stage kidney disease (ESKD, estimated glomerular filtration rate [eGFR] <15 ml/min per 1.73 m2) despite advances in remission-induction treatment. Methods: This is a retrospective cohort study on myeloperoxidase (MPO)-ANCA or proteinase 3 (PR3)-ANCA positive patients with AAV (microscopic polyangiitis, MPA; or granulomatosis with polyangiitis, GPA) and eGFR <15 ml/min per 1.73 m2 or ESKD at presentation. Renal recovery, dialysis discontinuation, and persistence of ESKD after standard remission-induction, with or without the use of plasma exchange (PLEX) were analyzed. Results: We analyzed 166 patients with biopsy-proven active AAV-GN and eGFR <15 ml/min per 1.73 m2 at the time of diagnosis. Patients received glucocorticoids with cyclophosphamide (CYC) (n = 84) or with rituximab (RTX) (n = 72) for remission-induction, and 49 received PLEX. The predictors of renal recovery were erythrocyte sedimentation rate, serum creatinine (SCr) at diagnosis, and minimal or mild chronicity changes. We further analyzed 71 patients who started dialysis with or without PLEX within 4 weeks of AAV-GN diagnosis. The predictors of dialysis discontinuation were minimal chronicity changes in kidney biopsy at diagnosis (odds ratio = 6.138; 95% confidence interval [CI]: 1.389–27.118; P = 0.017). Predictors of persistence of ESKD within 12 months included higher SCr at diagnosis (incidence rate ratio [IRR] = 1.086; 95% CI: 1.005–1.173; P = 0.037), and moderate (IRR = 3.797; 95% CI: 1.090–13.225; P = 0.036), or severe chronicity changes in kidney biopsy (IRR = 5.883; 95% CI: 1.542–22.439; P =0.009). Conclusion: In our cohort, kidney recovery, dialysis discontinuation, and persistence of ESKD in patients with AAV-GN and eGFR <15 ml/min per 1.73 m2 depended on SCr and histologic findings on kidney biopsies at the time of diagnosis and was not affected by the addition of PLEX.http://www.sciencedirect.com/science/article/pii/S2468024924015213ANCAchronicity changesglomerulonephritiskidney biopsyplasma exchangevasculitis |
| spellingShingle | Marta Casal Moura Dalia Zubidat Marc Patricio Liebana Sanjeev Sethi Maria Jose Soler Ladan Zand Fernanda G. dos Santos Luca Nardelli Juan Leon-Roman Ciria Sousa Kenneth J. Warrington Ulrich Specks Fernando C. Fervenza Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease Kidney International Reports ANCA chronicity changes glomerulonephritis kidney biopsy plasma exchange vasculitis |
| title | Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease |
| title_full | Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease |
| title_fullStr | Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease |
| title_full_unstemmed | Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease |
| title_short | Predictive Factors of Renal Recovery and Progression to End-Stage Kidney Disease in Patients With Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Severe Kidney Disease |
| title_sort | predictive factors of renal recovery and progression to end stage kidney disease in patients with antineutrophil cytoplasmic autoantibody associated vasculitis with severe kidney disease |
| topic | ANCA chronicity changes glomerulonephritis kidney biopsy plasma exchange vasculitis |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924015213 |
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