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Therapy and prognosis of ANCA-associated vasculitis from the clinical nephrologist’s perspective

  • Nephrology – Review
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Abstract

This paper reviews the recently published scientific information regarding ANCA-associated vasculitis (AAV), aiming to highlight the most important data from the clinical nephrologists’ perspective. The classification, pathomechanism, recent achievements of the treatment, short-term and long-term outcomes of the disease, and the difficulties nephrologists face when taking care for patients with AAV are summarized. There has been significant progress in the understanding of the genetic and pathologic background of the disease in the last years, and results of histological studies guide us to predict long-term renal function. Findings of several multicentered trials with reasonable number of participants provide comparison of the efficacy and safety of different remission induction and maintenance therapies, and evaluate recently introduced immunosuppressive agents. Although the clinical outcome of patients with AAV has improved significantly since modern immunosuppressive drugs are available, the treatment-related complications still contribute to the morbidity and mortality. To improve the survival and quality of life of patients with AAV further, knowledge of the predictors of relapse, end-stage kidney disease, and mortality, also prevention of infections and other treatment-related adverse events are important. The eligibility for renal transplantation and the option for successful pregnancies for young women are also important factors which influence the patients’ quality of life. In order to provide favorable outcome, the clinicians need to establish personalized treatment strategies to optimize the intensity and minimize the toxicity of the immunosuppressive therapy.

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References

  1. Jayne D (2009) Review article: progress of treatment in ANCA-associated vasculitis. Nephrology 14:42–48

    Article  CAS  PubMed  Google Scholar 

  2. Hamour S, Salama AD, Pusey CD (2010) Management of ANCA-associated vasculitis: current trends and future prospects. Ther Clin Risk Manag 6:253–264

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Falk RJ, Nachman PH, Hogan SL, Jennette JC (2000) ANCA glomerulonephritis and vasculitis: a Chapel Hill perspective. Semin Nephrol 20:233–243

    CAS  PubMed  Google Scholar 

  4. Lane SE, Watts RA, Shepstone L, Scott DGI (2005) Primary systemic vasculitis: clinical features and mortality. Q J Med 98:97–111

    Article  CAS  Google Scholar 

  5. Watts RA, Mahr A, Mohammad AJ et al (2015) Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant 30:i14–i22

    PubMed  Google Scholar 

  6. Harpel L, Savage CO (2005) ANCA-associated renal vasculitis at the end of the twentieth century—a disease of older patients. Rheumatology 44:495–501

    Article  Google Scholar 

  7. Jenette JC, Falk RJ, Andrassy K et al (1994) Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum 37:187–192

    Article  Google Scholar 

  8. Jennette JC, Falk RJ, Bacon PA et al (2013) 2012 revisited international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11

    Article  CAS  PubMed  Google Scholar 

  9. Westman KWA, Bygren PG, Olsson H et al (1998) Relapse rate, renal survival, and cancer morbidity in patients with Wegener’s granulomatosis or microscopic polyangiitis with renal involvement. J Am Soc Nephrol 9:842–852

    CAS  PubMed  Google Scholar 

  10. Lionaki S, Blyth ER, Hogan SL et al (2012) Classification of antineutrophil cytoplasmic autoantibody vasculitides. Arthritis Rheum 64:3452–3462

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Casian A, Jayne D (2011) Management of alveolar hemorrhage in lung vasculitides. Semin Respir Crit Care Med 32:335–345

    Article  PubMed  Google Scholar 

  12. Alberici F, Martorana D, Vaglio A (2015) Genetic aspects of anti-neutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant 30:i37–i45

    PubMed  Google Scholar 

  13. Lyons PA, Rayner TF, Trivedi S et al (2012) Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med 367:214–223

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Smith RM, Jones RB, Jayne DRW (2012) Progress in treatment of ANCA-associated vasculitis. Arthritis Res Ther 4:210. http://arthritis-research.com/content/14/2/210

  15. Schönermarck U, Csernok E, Gross WL (2015) Pathogenesis of anti-neutrophil cytoplasmic antibody-associated vasculitis: challenges and solutions 2014. Nephrol Dial Transplant 30:i46–i52

    PubMed  Google Scholar 

  16. Suppiah R, Hadden RDM, Batra R et al (2011) Peripheral neuropathy in ANCA-associated vasculitis: outcomes from the European vasculitis study group trials. Rheumatology 50:2214–2222

    Article  PubMed  Google Scholar 

  17. Weiner M, Goh SM, Mohammad AJ et al (2015) Outcome and treatment of elderly patients with ANCA-associated vasculitis. Clin J Am Soc Nephrol 10:1128–1135

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hoffman GS, Kerr GS, Leavitt RY et al (1992) Wegener granulomatosis. An analysis of 158 patients. Ann Intern Med 116:448–498

    Article  Google Scholar 

  19. Rasmussen N, Jayne DRW, Abramowicz D et al (1995) European therapeutic trials in ANCA-associated systemic vasculitis: disease scoring, consensus regimens and proposed clinical trials. Clin Exp Immunol 101(Suppl 1):29–34

    Article  Google Scholar 

  20. Jayne D, Rasmussen N (2015) Twenty-five years of European Union collaboration in ANCA-associated vasculitis. Nephrol Dial Transplant 30:i1–i7

    PubMed  Google Scholar 

  21. Mukhtyar C, Lee R, Brown D et al (2009) Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis 68:1827–1832

    Article  CAS  PubMed  Google Scholar 

  22. Flossmann O, Berden A, de Groot K et al (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis 70:488–494

    Article  PubMed  Google Scholar 

  23. Itabashi M, Takei T, Yabuki Y et al (2010) Clinical outcome and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis in Japan. Nephron Clin Pract 115:c21–c27

    Article  CAS  PubMed  Google Scholar 

  24. Corral-Gudino L, Borao-Cengotita-Bengoa M, del Pino-Montes J, Lerma-Márquez JL (2011) Overall survival, renal survival and relapse in patients with microscopic polyangiitis: a systematic review of current evidence. Rheumatology 50:1414–1423

    Article  PubMed  Google Scholar 

  25. Weidanz F, Day CJ, Hewins P et al (2007) Recurrences and infections during continuous immunosuppressive therapy after beginning dialysis in ANCA-associated vasculitis. Am J Kidney Dis 50:36–46

    Article  PubMed  Google Scholar 

  26. Jayne DRW, Gaskin G, Rasmussen N et al (2007) Randomized trial of plasma exchange or high-dosage methylprednisolone as adjunctive therapy for severe renal vasculitis. J Am Soc Nephrol 18:2180–2188

    Article  CAS  PubMed  Google Scholar 

  27. Bomback AS, Appel GB, Radhakrishnan J et al (2011) ANCA-associated glomerulonephritis in the very elderly. Kidney Int 79:757–764

    Article  PubMed  Google Scholar 

  28. Haris Á, Polner K, Arányi J et al (2014) Clinical outcomes of ANCA-associated vasculitis in elderly patients. Int Urol Nephrol 46:1595–1600

    Article  CAS  PubMed  Google Scholar 

  29. Little MA, Nazar L, Farrington K (2004) Outcome in glomerulonephritis due to systemic small vessel vasculitis: effect of functional status and non-vasculitic co-morbidity. Nephrol Dial Transplant 19:356–364

    Article  PubMed  Google Scholar 

  30. Little MA, Nightingale P, Verburgh CA et al (2010) Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis. Ann Rheum Dis 69:1036–1043

    Article  PubMed  Google Scholar 

  31. Lionaki S, Hogan SL, Jenette CE et al (2009) The clinical course of ANCA small-vessel vasculitis on chronic dialysis. Kidney Int 76:644–651

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hruskova Z, Honsova E, Berden AE et al (2014) Repeat protocol renal biopsy in ANCA-associated renal vasculitis. Nephrol Dial Transplant 29:1728–1732

    Article  PubMed  Google Scholar 

  33. de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R et al (2006) Clinical and histologic determinants of renal outcome in ANCA-associated vasculitis: a prospective analysis of 100 patients with severe renal involvement. J Am Soc Nephrol 17:2264–2274

    Article  Google Scholar 

  34. Bajema IM, Hagen EC, Hermans J et al (1999) Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis. Kidney Int 56:1751–1758

    Article  CAS  PubMed  Google Scholar 

  35. Quintana LF, Peréz NS, De Sousa E et al (2014) ANCA serotype and histopathological classification for the prediction of renal outcome in ANCA-associated glomerulonephritis. Nephrol Dial Transplant 29:1764–1769

    Article  CAS  PubMed  Google Scholar 

  36. van Daalen E, Ferrario F, Noel L-H et al (2015) Twenty-five years of RENHIS: a history of histopathological studies within EUVAS. Nephrol Dial Transplant 30:i31–i36

    PubMed  Google Scholar 

  37. Berden AE, Ferrario F, Hagen EC et al (2010) Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628–1636

    Article  PubMed  Google Scholar 

  38. Romeu M, Couchoud C, Delaroziére J-C et al (2014) Survival of patients with ANCA-associated vasculitis on chronic dialysis: data from the French REIN registry from 2002 to 2011. Q J Med 107:545–555

    Article  CAS  Google Scholar 

  39. Hruskova Z, Stel VS, Jayne D et al (2015) Characteristics and outcome of granulomatosis with polyangiitis (Wegener) and microscopic polyangiitis requiring renal replacement therapy: results from the European Renal Association–European Dialysis and Transplant Association Registry. Am J Kidney Dis 66:613–620

    Article  PubMed  Google Scholar 

  40. Pagnoux C, Hogan SL, Chin H et al (2008) Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis. Arthritis Rheum 58:2908–2918

    Article  PubMed  PubMed Central  Google Scholar 

  41. Despujol CP-D, Pouchot J, Pagnoux C et al (2010) Predictors at diagnosis of a first Wegener’s granulomatosis relapse after obtaining complete remission. Rheumatology 49:2181–2190

    Article  Google Scholar 

  42. Walsh M, Flossmann O, Berden A et al (2012) Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 64:542–548

    Article  CAS  PubMed  Google Scholar 

  43. Harper L, Morgan MD, Walsh M et al (2102) Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis: long-term follow-up. Ann Rheum Dis 71:955–960

    Article  Google Scholar 

  44. Merino JL, Galeano C, Espejo B et al (2011) A retrospective study on outcome of microscopic polyangiitis in chronic renal replacement therapy. Nephrol Dial Transplant 26:1360–1366

    Article  PubMed  Google Scholar 

  45. Miloslavsky EM, Specks U, Merkel PA et al (2013) Clinical outcomes of remission induction therapy for severe antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum 65:2441–2449

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Guillevin L (2014) Treatment of severe and/or refractory ANCA-associated vasculitis. Curr Rheumatol Rep 16:430

    Article  PubMed  Google Scholar 

  47. (2012) Chapter 13: Pauci-immune focal and segmental necrotizing glomerulonephritis. Kidney Int Suppl 2(2): 233–239. doi:10.1038/kisup.2012.26

  48. Yates M, Watts RA, Bajema IM et al (2016) EULAR/ERA-EDTA recommendations for the management of ANCA-associated vasculitis. Ann Rheum Dis. doi:10.1136/annrheumdis-2016-209133

    Google Scholar 

  49. Fauci AS, Haynes BF, Katz P, Wolff SM (1983) Wegener’s granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 98:76–85

    Article  CAS  PubMed  Google Scholar 

  50. de Groot K, Harper L, Jayne DRW et al (2009) Pulse versus daily oral cyclophosphamide for induction of remission in antineutrophil cytoplasmic antibody-associated vasculitis. Ann Intern Med 150:670–680

    Article  PubMed  Google Scholar 

  51. Le Guenno G, Mahr A, Pagnoux C, Dhote R, Guillevin L; French Vasculitis Study Group et al (2011) Incidence and predictors of urotoxic adverse events in cyclophosphamide-treated patients with systemic necrotizing vasculitides. Arthritis Rheum 63:1435–1445

    Article  CAS  PubMed  Google Scholar 

  52. Walsh M, Catapano F, Szpirt W et al (2011) Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis. Am J Kidney Dis 57:566–574

    Article  PubMed  Google Scholar 

  53. Pepper RJ, Chanouzas D, Tarzi R et al (2013) Intravenous cyclophosphamide and plasmapheresis in dialysis-dependent ANCA-associated vasculitis. Clin J Am Soc Nephrol 8:219–224

    Article  CAS  PubMed  Google Scholar 

  54. Walsh M, Casian A, Flossmann O et al (2013) Long-term follow-up of patients with severe ANCA-associated vasculitis comparing plasma exchange to intravenous methylprednisolone treatment is unclear. Kidney Int 84:397–402

    Article  CAS  PubMed  Google Scholar 

  55. Szpirt WM, Heaf JG, Petersen J (2011) Plasma exchange for induction and cyclosporine A for maintenance of remission in Wegener’s granulomatosis – a clinical randomized controlled trial. Nephrol Dial Transplant 26:206–213

    Article  CAS  PubMed  Google Scholar 

  56. Gregensen JW, Kristensen T, Krag SRP et al (2012) Early plasma exchange improves outcome in PR3-ANCA-positive renal vasculitis. Clin Exp Rheumatol 30(Suppl 70):S39–S47

    Google Scholar 

  57. Walsh M, Merkel PA, Peh CA et al (2013) Plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody associated vasculitis (PEXIVAS): protocol for a randomized controlled trial. BioMed Cent. doi:10.1186/1745-6215-14-73

    Google Scholar 

  58. de Joode AAE, Sanders JSF, Rutgers A, Stegeman CA (2015) Maintenance therapy in antineutrophil cytoplasmic antibody-associated vasculitis: who needs what and for how long? Nephrol Dial Transplant 30:i150–i158

    PubMed  Google Scholar 

  59. Walsh M, Merkel PA, Mahr A, Jayne D (2010) The effects of duration of glucocorticoid therapy on relapse rate in anti-neutrophil cytoplasm antibody associated vasculitis: a meta-analysis. Arthritis Care Res 62:1166–1173

    Article  Google Scholar 

  60. Jayne D, Rasmussen N, Andrassy K et al (2003) A randomized trial of maintenance therapy for vasculitis associated with antineutrophil cytoplasmic autoantibodies. N Engl J Med 349:36–44

    Article  CAS  PubMed  Google Scholar 

  61. Stone JH, Merkel PA, Spiera R et al (2010) Rituximab versus cyclophosphamide for ANCA-associated vasculitis. N Engl J Med 363:221–232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Specks U, Merkel PA, Seo P et al (2013) Efficacy of remission-induction regimens for ANCA-associated vasculitis. N Engl J Med 369:417–427

    Article  CAS  PubMed  Google Scholar 

  63. Besada E, Koldingsnes W, Nossent JC (2013) Long-term efficacy and safety of pre-emptive maintenance therapy with rituximab in granulomatosis with polyangiitis: results from a single centre. Rheumatology 52:2041–2047

    Article  CAS  PubMed  Google Scholar 

  64. Jones RB, Tervaert JWC, Hauser T et al (2010) Rituximab versus cyclophosphamide in ANCA-associated renal vasculitis. N Engl J Med 363:211–220

    Article  CAS  PubMed  Google Scholar 

  65. Charles P, Néel A, Tieulié N et al (2014) Rituximab for induction and maintenance treatment of ANCA-associated vasculitides: a multicentre retrospective study on 80 patients. Rheumatology 53:532–539

    Article  CAS  PubMed  Google Scholar 

  66. Guerry M-JCJ, Brogan P, Bruce IN et al (2012) Recommendations for the use of rituximab in anti-neutrophil cytoplasm antibody-associated vasculitis. Rheumatology 51:634–643

    Article  CAS  PubMed  Google Scholar 

  67. Guillevin L, Pagnoux C, Karras A et al (2014) Rituximab versus azathioprine for maintenance in ANCA-associated vasculitis. N Engl J Med 371:1771–1780

    Article  PubMed  Google Scholar 

  68. Kronbichler A, Jayne DRW (2015) Con: should all patients with anti-neutrophil cytoplasmic antibody-associated vasculitis be primarily treated with rituximab? Nephrol Dial Transplant 30:1075–1081

    Article  PubMed  Google Scholar 

  69. Specks U (2015) Pro: should all patients with anti-neutrophil cytoplasmic antibody-associated vasculitis be primarily treated with rituximab? Nephrol Dial Transplant 30:1083–1087

    Article  PubMed  PubMed Central  Google Scholar 

  70. Tesar V (2015) Moderator’s view: should all patients with ANCA-associated vasculitis be primarily treated with rituximab? Nephrol Dial Transplant 30:1088–1090

    Article  PubMed  Google Scholar 

  71. Szilasi M, Mátyus J, File I et al (2012) Association of ANCA-associated vasculitis-rheumatoid arthritis overlap syndrome in four patients: rituximab may be the right choice? Autoimmunity 45:304–309

    Article  CAS  PubMed  Google Scholar 

  72. Hiemstra TF, Walsh M, Mahr A et al (2010) Mycophenolate mofetil vs azathioprine for remission maintenance in antineutrophil cytoplasmic antibody-associated vasculitis. JAMA 304:2381–2388

    Article  CAS  PubMed  Google Scholar 

  73. Draibe J, Poveda R, Fulladosa X et al (2015) Use of mycophenolate in ANCA-associated renal vasculitis: 13 years of experience at a university hospital. Nephrol Dial Transplant 30:i132–i137

    PubMed  Google Scholar 

  74. Schaier M, Scholl C, Scharpf D et al (2015) High interpatient variability in response to mycophenolic acid maintenance therapy in patients with ANCA-associated vasculitis. Nephrol Dial Transplant 30:i138–i145

    PubMed  Google Scholar 

  75. Jayne DRW, Chapel H, Adu D et al (2000) Intravenous immunoglobulin for ANCA-associated systemic vasculitis with persistent disease activity. Q J Med 93:433–439

    Article  CAS  Google Scholar 

  76. Flossmann O, Jayne DRW (2010) Long-term treatment of relapsing Wegener’s granulomatosis with 15-deoxyspergualin. Rheumatology 49:556–562

    Article  CAS  PubMed  Google Scholar 

  77. Furuta S, Jayne D (2014) Emerging therapies in antineutrophil cytoplasm antibody-associated vasculitis. Curr Opin Rheumatol 26:1–6

    Article  CAS  PubMed  Google Scholar 

  78. McGregor JG, Hogan SL, Hu Y et al (2012) Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin J Am Soc Nephrol 7:240–247

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. McGregor JG, Hogan SL, Kotzen ES et al (2015) Rituximab as an immunosuppressant in antineutrophil cytoplasmic antibody-associated vasculitis. Nephrol Dial Transplant 30:i123–i131

    PubMed  PubMed Central  Google Scholar 

  80. McGregor JG, Negrete-Lopez R, Poulton CJ et al (2015) Adverse events and infectious burden, microbes and temporal outline from immunosuppressive therapy in antineutrophil cytoplasmic antibody-associated vasculitis with native renal function. Nephrol Dial Transplant 30:i171–i181

    PubMed  PubMed Central  Google Scholar 

  81. Charlier C, Henegar C, Launay O et al (2009) Risk factors for major infections in Wegener granulomatosis: analysis of 113 patients. Ann Rheum Dis 68:658–663

    Article  CAS  PubMed  Google Scholar 

  82. Heijl C, Harpel L, Flossmann O et al (2011) Incidence of malignancy in patients treated for antineutrophil cytoplasm antibody-associated vasculitis: follow-up data from European vasculitis study group clinical trials. Ann Rheum Dis 70:1415–1421

    Article  CAS  PubMed  Google Scholar 

  83. Shang W, Ning Y, Xu X et al (2015) Incidence of cancer in ANCA-associated vasculitis: a meta-analysis of observational studies. PLoS One. doi:10.1371/journal.pone.0126016

    Google Scholar 

  84. Faurschou M, Mellemkjaer L, Voss A et al (2015) Prolonged risk of specific malignancies following cyclophosphamide therapy among patients with granulomatosis with polyangiitis. Rheumatology 54:1345–1350

    Article  PubMed  Google Scholar 

  85. Huong DLT, Amoura Z, Duhaut P et al (2002) Risk of ovarian failure and fertility after intravenous cyclophosphamide. A study in 84 patients. J Rheumatol 29:2571–2576

    CAS  PubMed  Google Scholar 

  86. Tesar V, Hruskova Z (2014) Limitations of standard immunosuppressive treatment in ANCA-associated vasculitis and lupus nephritis. Nephron Clin Pract 128:205–215

    Article  CAS  PubMed  Google Scholar 

  87. Pagnoux C, Guern VL, Goffinet F et al (2011) Pregnancies in systemic necrotizing vasculitides: report on 12 women and their 20 pregnancies. Rheumatology 50:953–961

    Article  PubMed  Google Scholar 

  88. Tuin J, Sanders JSF, de Joode AAE, Stegeman CA (2012) Pregnancy in women diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis: outcome for the mother and the child. Arthritis Care Res 64:539–545

    Article  CAS  Google Scholar 

  89. Alfhaily F, Watts R, Leather A (2009) Wegener’s granulomatosis occurring de novo during pregnancy. Clin Exp Rheumatol 27(Suppl. 52):S86–S88

    CAS  PubMed  Google Scholar 

  90. Nachman PH, Segelmark M, Westman K et al (1999) Recurrent ANCA-associated small vessel vasculitis after transplantation: a pooled analysis. Kidney Int 56:1544–1550

    Article  CAS  PubMed  Google Scholar 

  91. Geetha D, Eirin A, True K et al (2011) Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis: a multicenter experience. Transplantation 91:1370–1375

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Little MA, Hassan B, Jacques S et al (2009) Renal transplantation in systemic vasculitis: when is it safe? Nephrol Dial Transplant 24:3219–3225

    Article  PubMed  Google Scholar 

  93. Moran S, Little MA (2014) Renal transplantation in antineutrophil cytoplasmic antibody-associated vasculitis. Curr Opin Rheumatol 26:37–41

    Article  CAS  PubMed  Google Scholar 

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  1. Nephrology Department, Szent Margit Hospital, 132 Bécsi Street, Budapest, 1032, Hungary

    Ágnes Haris, Szilveszter Dolgos & Kálmán Polner

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  1. Ágnes Haris
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Correspondence to Ágnes Haris.

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Haris, Á., Dolgos, S. & Polner, K. Therapy and prognosis of ANCA-associated vasculitis from the clinical nephrologist’s perspective. Int Urol Nephrol 49, 91–102 (2017). https://doi.org/10.1007/s11255-016-1419-4

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