Skip to main content

Advertisement

Log in

Impact of renal involvement on survival in ANCA-associated vasculitis

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

Renal involvement is a serious complication of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We describe the pattern of renal involvement and its correlation with outcomes.

Patients and methods

Medical records of 92 patients seen in rheumatology clinic and diagnosed as AAV between January 2007 and June 2014 were analysed. Patients were classified as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA) and undifferentiated AAV. Overall and renal outcomes were analysed. Patients were classified as advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), deranged RFT not qualifying the above parameters, and normal renal function.

Results

Sixty-seven (72.8 %) patients had GPA, 14 (15.2 %) had MPA, 8 (8.7 %) had EGPA, and 3 (3.3 %) had undifferentiated AAV. Renal involvement was seen in 51 (55.4 %) patients (46.3 % of GPA patients, 78.6 % of MPA, 37.5 % of EGPA and 33.3 % of unclassifiable AAV patients). Renal involvement was more common in males (p = 0.008). Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p < 0.01). Thirteen patients (25.5 %) presented with advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), 21 (41.2 %) had deranged renal functions but did not require dialysis, and the rest had proteinuria and active sediments with normal serum creatinine. Twenty-four patients (47.1 %) had good renal outcome with normal creatinine, 12 (23.5 %) had persistent renal insufficiency, 12 (23.5 %) died, and one (2 %) remained dialysis dependent. Mean survival and mortality did not differ in patients with and without renal involvement (p = 0.454, p = 0.388).

Conclusions

Renal involvement was more common in males. BVAS was higher in patients with renal involvement. The mean survival and mortality were similar in patients with or without renal involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Holle JU, Laudien M, Gross WL (2010) Clinical manifestations and treatment of Wegener’s granulomatosis. Rheum Dis Clin North Am 36:507–526

    Article  PubMed  Google Scholar 

  2. Sharma A, Gopalakrishan D, Nada R et al (2014) Uncommon presentations of primary systemic necrotizing vasculitides: the Great Masquerades. Int J Rheum Dis 17:562–572

    PubMed  Google Scholar 

  3. Sharma A, Mittal T, Rajan R, Rathi M, Nada R, Minz RW, Joshi K, Sakhuja V, Singh S (2014) Validation of the consensus methodology algorithm for the classification of systemic necrotizing vasculitis in Indian patients. Int J Rheum Dis 17:408–411

    Article  PubMed  Google Scholar 

  4. Villiger PM, Guillevin L (2010) Microscopic polyangiitis: clinical presentation. Autoimmun Rev 9:812–819

    Article  PubMed  Google Scholar 

  5. Pagnoux C, Guilpain P, Guillevin L (2007) Churg–Strauss syndrome. Curr Opin Rheumatol 19:25–32

    Article  PubMed  Google Scholar 

  6. Leavitt RY, Fauci AS, Bloch DA, Michel BA, Hunder GG, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Wegener’s granulomatosis. Arthritis Rheum 33:1101–1107

    Article  CAS  PubMed  Google Scholar 

  7. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11

    Article  CAS  PubMed  Google Scholar 

  8. Suppiah R, Mukhtyar C, Flossmann O, Alberici F, Baslund B, Batra R et al (2011) A cross-sectional study of the Birmingham Vasculitis Activity Score version 3 in systemic vasculitis. Rheumatology (Oxford) 50:899–905

    Article  Google Scholar 

  9. Aasarod K, Iversen BM, Hammerstrom J, Bostad L, Vatten L, Jorstad S (2000) Wegener’s granulomatosis: clinical course in 108 patients with renal involvement. Nephrol Dial Transplant 15:611–618

    Article  CAS  PubMed  Google Scholar 

  10. Guillevin L, Durand-Gasselin B, Cevallos R, Gayraud M, Lhote F, Callard P et al (1999) Microscopic polyangiitis: clinical and laboratory findings in eighty-five patients. Arthritis Rheum 42:421–430

    Article  CAS  PubMed  Google Scholar 

  11. Reinhold-Keller E, Beuge N, Latza U, de Groot K, Rudert H, Nölle B et al (2000) An interdisciplinary approach to the care of patients with Wegener’s granulomatosis: long-term outcome in 155 patients. Arthritis Rheum 43:1021–1032

    Article  CAS  PubMed  Google Scholar 

  12. Mohammad AJ, Jacobsson LT, Westman KW, Sturfelt G, Segelmark M (2009) Incidence and survival rates in Wegener’s granulomatosis, microscopic polyangiitis, Churg–Strauss syndrome and polyarteritisnodosa. Rheumatology 48:1560–1565

    Article  PubMed  Google Scholar 

  13. Fujimoto S, Watts RA, Kobayashi S, Suzuki K, Jayne DR, Scott DG et al (2011) Comparison of the epidemiology of anti-neutrophil cytoplasmic antibody-associated vasculitis between Japan and the U.K. Rheumatology 50:1916–1920

    Article  PubMed  Google Scholar 

  14. Liu LJ, Chen M, Yu F, Zhao MH, Wang HY (2008) Evaluation of a new algorithm in classification of systemic vasculitis. Rheumatology 47:708–712

    Article  PubMed  Google Scholar 

  15. Hilhorst M, Wilde B, van Paassen P, Winkens B, van Breda Vriesman P, Tervaert JWC (2013) Improved outcome in anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis: a 30-year follow-up study. Nephrol Dial Transplant 28(2):373–379

    Article  CAS  PubMed  Google Scholar 

  16. Rhee RL, Hogan SL, Poulton CJ, McGregor JA, Landis JR, Falk RJ et al (2016) Trends in long-term outcomes among patients with ANCA-associated vasculitis with renal disease. Arthritis Rheumatol. doi:10.1002/art.39614

    PubMed  Google Scholar 

  17. Booth AD, Almond MK, Burns A, Ellis P, Gaskin G, Neild GH, Pan-Thames Renal Research Group et al (2003) Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study. Am J Kidney Dis 41:776–784

    Article  PubMed  Google Scholar 

  18. de Groot K, Harper L, Jayne DR, Suarez LFF, Gregorini G, Gross WL, EUVAS (European Vasculitis Study Group) et al (2009) Pulse versus daily oral cyclophosphamide for induction of remission in anti-neutrophil cytoplasmic antibody-associated vasculitis: a randomized trial. Ann Intern Med 150:670–680

    Article  PubMed  Google Scholar 

  19. Weidner S, Geuss S, Hafezi-Rachti S, Wonka A, Rupprecht HD (2004) ANCA-associated vasculitis with renal involvement: an outcome analysis. Nephrol Dial Transplant 19:1403–1411

    Article  PubMed  Google Scholar 

  20. Hauer HA, Bajema IM, Van Houwelingen HC, Ferrario F, Noël LH, Waldherr R, European Vasculitis Study Group (EUVAS) et al (2002) Determinants of outcome in ANCA-associated glomerulonephritis: a prospective clinico-histopathological analysis of 96 patients. Kidney Int 62:1732–1742

    Article  PubMed  Google Scholar 

  21. Yumura W, Kobayashi S, Suka M, Hayashi T, Ito S, Nagafuchi H, JMAAV Study Group et al (2014) Assessment of the Birmingham vasculitis activity score inpatients with MPO-ANCA-associated vasculitis: sub-analysis from a study by the Japanese Study Group for MPO-ANCA-associated vasculitis. Mod Rheumatol 24:304–309

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Aman Sharma.

Ethics declarations

Conflict of interest

None.

Additional information

Manish Rathi and Aman Sharma have contributed equally as first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rathi, M., Pinto, B., Dhooria, A. et al. Impact of renal involvement on survival in ANCA-associated vasculitis. Int Urol Nephrol 48, 1477–1482 (2016). https://doi.org/10.1007/s11255-016-1330-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-016-1330-z

Keywords

Navigation