Clinical associations of renal involvement in ANCA-associated vasculitis.

Autor: Kronbichler A; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria. Electronic address: andreas.kronbichler@i-med.ac.at., Shin JI; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea., Lee KH; Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea., Nakagomi D; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Third Internal Medicine, University of Yamanashi, Yamanashi, Japan., Quintana LF; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, Barcelona, Spain., Busch M; Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, Jena, Germany., Craven A; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK., Luqmani RA; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK., Merkel PA; Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA., Mayer G; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria., Jayne DRW; Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Medicine, University of Cambridge, CB2 0QQ Cambridge, United Kingdom., Watts RA; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Jazyk: angličtina
Zdroj: Autoimmunity reviews [Autoimmun Rev] 2020 Apr; Vol. 19 (4), pp. 102495. Date of Electronic Publication: 2020 Feb 15.
DOI: 10.1016/j.autrev.2020.102495
Abstrakt: Objective: Renal involvement in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis is associated with significant morbidity and higher mortality rates. This study examined clinical manifestations associated with renal involvement in ANCA-associated vasculitis within a large, international cross-sectional cohort.
Methods: Univariate and multivariate analyses were performed to identify clinical factors associated with renal disease, which was defined as i) a serum-creatinine >30% above normal and a fall in creatinine-clearance >25%; or ii) haematuria attributable to active vasculitis.
Results: The study cohort include 1230 patients from 31 countries; 723 (58.8%) presented with renal involvement: microscopic polyangiitis (82.2%), granulomatosis with polyangiitis (58.6%), and eosinophilic granulomatosis with polyangiitis (26.4%). The following clinical and laboratory factors were more common among patients with renal disease: age (OR 1.01, 95% CI 1.01-1.02), fever (OR 1.97, 95% CI 1.35-2.88), fatigue (OR 1.55, 95% CI 1.14-2.10), weight loss (OR 1.62, 95% CI 1.23-2.12), polyarthritis (OR 1.39, 95% CI 1.02-1.89), petechiae/purpura (OR 1.47, 95% CI 1.06-2.05), pulmonary haemorrhage (OR 5.23, 95% CI 1.39-19.63), gastrointestinal symptoms (OR 2.19, 95% CI 1.34-3.58), seizures (OR 3.42, 95% CI 1.26-9.30), lower serum albumin (OR 2.42, 95% CI 1.64-3.57), higher CRP (OR 2.06, 95% CI 1.04-4.06), low serum C3 at baseline (OR 3.86, 95% CI 1.30-11.53), myeloperoxidase- (OR 7.97, 95% CI 2.74-23.20) and proteinase 3-ANCA (OR 3.40, 95% CI 1.22-9.50). The following clinical factors were less common among patients with renal disease: mononeuritis multiplex (OR 0.63, 95% CI 0.41-0.98), proptosis/exophthalmos (OR 0.19, 95% CI 0.06-0.59), nasal polyps (OR 0.32, 95% CI 0.19-0.55), septal defect/perforation (OR 0.29, 95% CI 0.14-0.60), respiratory distress/pulmonary fibrosis/asthma (OR 0.08, 95% CI 0.04-0.19), and wheeze/obstructive airway disease (OR 0.29, 95% CI 0.16-0.52).
Conclusion: In this large international study, several clinical and laboratory factors were identified as associated with renal involvement in ANCA-associated vasculitis.
Competing Interests: Declaration of Competing Interest Dr. Kronbichler received consulting fees from Vifor Pharma and speaking fees from Novartis, TerumoBCT and Miltenyi Biotech. Dr. Luqmani received research support from Roche, Vifor Pharma and InflaRx and speaking fees from Roche. Dr. Merkel received research support from AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, ChemoCentryx, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, Kypha and TerumoBCT, consulting fees from Abbvie, AstraZeneca, Biogen, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, ChemoCentryx, CSL Behring, Genentech/Roche, Genzyme/Sanofi, GlaxoSmithKline, InflaRx, Insmed, Jannsen, Kiniksa, royalties from UpToDate. Dr. Jayne received received research grants from ChemoCentryx, GlaxoSmithKline, Genentech/Roche and Genzyme/Sanofi, and consulting fees from AstraZeneca, Boehringer-Ingelheim, Celgene, Insmed and Takeda. All potential conflicts of interest are outside the submitted work. All other authors report no potential conflicts.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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