Predictors of renal and patient outcomes in anti-neutrophil cytoplasmic antibody-associated vasculitis: Our single-center, tertiary care experience
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2021
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Objectives: This study aims to assess the different predictors of renal and patient prognosis in anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) patients with and without renal involvement. Patients and methods: A total of 79 patients (51 males, 28 females; mean age: 57.3±14.2 years; range, 18 to 71 years) with AAV between January 2006 and November 2019 were retrospectively analyzed. Demographic and laboratory data including the complement 3 (C3) serum levels and renal biopsy findings were extracted from the electronic and printed medical records of the hospital registry. Survival, renal survival, remission, and relapse outcomes were analyzed. Results: A total of 35% of the patients with renal involvement progressed to end-stage renal disease (ESRD). The dialysis requirement at the time of admission (hazard ratio [HR]: 21.95 [2.93-164.22]; p=0.003), estimated glomerular filtration rate (eGFR) (HR: 0.97 [0.94-0.99]; p=0.024) and Five-Factor Score (FFS) ≥2 at the time of diagnosis (HR: 3.59 [1.08-11.94]; p=0.037) were the predictors of ESRD. The five-year patient survival rate was 87.1%. The only predictor of mortality was age (HR: 1.07 [1.01-1.14]; p=0.024). The patients with hypocomplementemia (22%) had a lower remission rate (p=0.049), FFS ≥2 at the time of diagnosis (p=0.026), and higher levels of hematuria (p=0.004) and proteinuria (p=0.037). The FFS ≥2 at the time of diagnosis was an independent predictor of relapse (HR: 8.9 [1.02-77.36]; p=0.047). Conclusion: Our study suggests that the baseline renal function and FFS ≥2 at the time of diagnosis are the major prognostic factors for progression to ESRD in AAV patients. In addition, AAV patients with hypocomplementemia may have a lower remission rate. © 2021 Turkish League Against Rheumatism. All rights reserved.
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albumin , antinuclear antibody , azathioprine , C reactive protein , complement component C3 , complement component C4 , creatinine , cyclophosphamide , ferritin , glucocorticoid , hemoglobin , methotrexate , myeloblastin , myeloperoxidase , neutrophil cytoplasmic antibody , rituximab , adult , aged , ANCA associated vasculitis , arthralgia , arthritis , Article , blood cell count , cardiovascular disease assessment , computer assisted tomography , conjunctivitis , dialysis , end stage renal disease , episcleritis , erythrocyte sedimentation rate , estimated glomerular filtration rate , female , Five Factor Score , glomerulonephritis , hearing impairment , hematuria , hemodialysis , histopathology , human , human tissue , hypertension , hypocomplementemia , immunofluorescence , immunosuppressive treatment , intestine infarction , intestine ischemia , intestine perforation , kidney biopsy , kidney failure , kidney function , leukocyturia , lung hemorrhage , lung nodule , major clinical study , male , middle aged , mortality , myocarditis , nuclear magnetic resonance imaging , pericarditis , plasmapheresis , prognosis , proteinuria , purpura , rash , recurrence free survival , relapse , remission , renal replacement therapy , retina vasculitis , retrospective study , scleritis , sinusitis , skin ulcer , subglottic stenosis , survival , survival rate , treatment outcome , urinalysis , uveitis , vasculitis