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Risk factors associated with relapse or infectious complications in Japanese patients with microscopic polyangiitis

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Abstract

Background

The prevention of relapse and infection complications during remission maintenance therapy is required to improve the prognosis of patients with microscopic polyangiitis (MPA) showing rapidly progressive glomerulonephritis (RPGN). The clinicopathological characteristics of patients with ANCA-positive MPA were examined to determine the risk factors for relapse or infectious complications after remission induction therapy.

Patients and methods

The study population consisted of 52 patients diagnosed as ANCA-positive MPA showing RPGN from 2002 to 2012, after publication of the Japanese guideline for RPGN. The clinicopathological findings were examined between the presence and absence of relapse or infectious complications.

Results

The value of vasculitis damage index (VDI) was high for the relapse group and VDI value was identified as the leading factor associated with relapse [hazard ratio (HR) 3.36, 95 % confidence interval (CI) 1.58–7.12, P < 0.01]. On the other hand, the values of Birmingham Vasculitis Activity Score, clinical grade category of RPGN at diagnosis, and VDI at remission were high in the infectious group. Furthermore, clinical grade category of RPGN was the leading factor associated with infectious complications (HR 5.30, 95 % CI 1.41–19.9, P = 0.01).

Conclusion

The disease activity at diagnosis and severity of organ damage at remission were associated with relapse and infectious complications during remission maintenance therapy and infectious complication affected kidney survival and all-cause mortality in patients with ANCA-positive MPA exhibiting RPGN.

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Acknowledgments

We thank the physicians and staff members at the collaborative institutions for participating in this study and for providing data. This work was financially supported in part by Grants-in-Aid from the Ministry of Education, Culture, Sports, Science, and Technology of the Japanese Government, for Progressive Renal Diseases Research, Research on Intractable Disease, and for Intractable Vasculitis from the Ministry of Health, Labour and Welfare of the Japanese Government.

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Authors and Affiliations

  1. Division of Internal Medicine, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan

    Kiyoki Kitagawa

  2. Division of Blood Purification, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Kengo Furuichi & Norihiko Sakai

  3. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan

    Kengo Furuichi, Akihiro Sagara, Yasuyuki Shinozaki, Shinji Kitajima, Tadashi Toyama, Akinori Hara, Yasunori Iwata, Norihiko Sakai, Miho Shimizu & Takashi Wada

  4. Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan

    Kengo Furuichi, Akihiro Sagara, Yasuyuki Shinozaki, Shinji Kitajima, Tadashi Toyama, Akinori Hara, Yasunori Iwata, Norihiko Sakai, Miho Shimizu & Shuichi Kaneko

  5. Department of Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan

    Yasunori Iwata & Takashi Wada

Authors
  1. Kiyoki Kitagawa
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  2. Kengo Furuichi
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  3. Akihiro Sagara
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  4. Yasuyuki Shinozaki
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  5. Shinji Kitajima
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  6. Tadashi Toyama
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  7. Akinori Hara
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  8. Yasunori Iwata
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  9. Norihiko Sakai
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  10. Miho Shimizu
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  11. Shuichi Kaneko
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  12. Takashi Wada
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Consortia

Kanazawa Study Group for Renal Diseases and Hypertension

Corresponding author

Correspondence to Kengo Furuichi.

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The authors declare that no conflicts of interest exist.

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Kitagawa, K., Furuichi, K., Sagara, A. et al. Risk factors associated with relapse or infectious complications in Japanese patients with microscopic polyangiitis. Clin Exp Nephrol 20, 703–711 (2016). https://doi.org/10.1007/s10157-015-1199-7

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  • DOI: https://doi.org/10.1007/s10157-015-1199-7

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