Prognostic Factors for Survival and Relapse in ANCA-Associated Vasculitis with Renal Involvement: A Clinical Long-Term Follow-Up Study
Joint Authors
Poussa, Tuija
Salmela, Anna
Törnroth, Tom
Ekstrand, Agneta
Source
International Journal of Nephrology
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-11, 11 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-10-16
Country of Publication
Egypt
No. of Pages
11
Main Subjects
Abstract EN
Aim.
We describe the clinical pattern of ANCA-associated vasculitis (AAV) and assess long-term prognostic factors of patients and renal survival and relapse.
Methods.
Data from 85 patients with renal biopsy-proven AAV at a single center with up to 20-year [median 16.2 years (95% CI 14.9-17.7)] follow-up were retrospectively collected.
Results.
Overall, 55% of the patients had microscopic polyangiitis (MPA) and 45% had granulomatosis with polyangiitis (GPA).
The histopathological classes were focal in 35%, crescentic in 26%, mixed in 20%, and sclerotic glomerulonephritis in 19% of the patients.
As induction treatment, a combination of cyclophosphamide and corticosteroids was given to 82%, while a combination of azathioprine and corticosteroids was maintenance therapy in 79%.
The twenty-year patient survival was 45%.
In a multivariable analysis, age ≥58 years [hazard ratio (HR) 7.64, 95% CI 3.44-16.95] and myeloperoxidase (MPO) ANCA (HR 2.12, 95% CI 1.08-4.17) were associated with shorter patient survival time.
Renal survival was 68% overall: 88% in focal, 71% in crescentic, 56% in mixed, and 37% in sclerotic class (p=0.01).
Female sex (HR 0.26, 95% CI 0.10-0.73) was a predictor of improved renal survival, whereas GFR <30 ml/min and MPO-ANCA were associated with worse renal survival (HR 4.10, 95% CI 1.35-12.49 and HR 3.10, 95% CI 1.21-7.95, respectively).
Relapse-free survival at 20 years was 10%.
MPA was associated with a lower risk for relapse (HR 0.48, 95% CI 0.28–0.82).
Conclusion.
We confirmed the improved patient and renal survival in AAV patients with glomerulonephritis, while relapse remained the primary challenge.
Histopathological classification may be relevant for survival.
American Psychological Association (APA)
Salmela, Anna& Törnroth, Tom& Poussa, Tuija& Ekstrand, Agneta. 2018. Prognostic Factors for Survival and Relapse in ANCA-Associated Vasculitis with Renal Involvement: A Clinical Long-Term Follow-Up Study. International Journal of Nephrology،Vol. 2018, no. 2018, pp.1-11.
https://search.emarefa.net/detail/BIM-1173652
Modern Language Association (MLA)
Salmela, Anna…[et al.]. Prognostic Factors for Survival and Relapse in ANCA-Associated Vasculitis with Renal Involvement: A Clinical Long-Term Follow-Up Study. International Journal of Nephrology No. 2018 (2018), pp.1-11.
https://search.emarefa.net/detail/BIM-1173652
American Medical Association (AMA)
Salmela, Anna& Törnroth, Tom& Poussa, Tuija& Ekstrand, Agneta. Prognostic Factors for Survival and Relapse in ANCA-Associated Vasculitis with Renal Involvement: A Clinical Long-Term Follow-Up Study. International Journal of Nephrology. 2018. Vol. 2018, no. 2018, pp.1-11.
https://search.emarefa.net/detail/BIM-1173652
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1173652