Clinical associations of renal involvement in ANCA-associated vasculitis

被引：55

作者：

Kronbichler, Andreas ^{[1
,2
]}

Shin, Jae Il ^{[3
,4
]}

Lee, Keum Hwa ^{[3
,4
]}

Nakagomi, Daiki ^{[1
,5
]}

Quintana, Luis F. ^{[1
,6
]}

Busch, Martin ^{[7
]}

Craven, Anthea ^{[8
]}

Luqmani, Raashid A. ^{[8
]}

Merkel, Peter A. ^{[9
,10
]}

Mayer, Gert ^{[2
]}

Jayne, David R. W. ^{[1
,11
]}

Watts, Richard A. ^{[12
]}

机构：

[1] Addenbrookes Hosp, Vasculitis & Lupus Clin, Hills Rd, Cambridge CB2 0QQ, England

[2] Med Univ Innsbruck, Dept Internal Med Nephrol & Hypertens 4, Innsbruck, Austria

[3] Yonsei Univ, Dept Pediat, Coll Med, Seoul, South Korea

[4] Severance Childrens Hosp, Div Pediat Nephrol, Seoul, South Korea

[5] Univ Yamanashi, Dept Internal Med 3, Kofu, Yamanashi, Japan

[6] Univ Barcelona, Hosp Clin, Ctr Referencia Enfermedad Glomerular Compleja Sis, Dept Med,Dept Nephrol & Renal Transplantat, Barcelona, Spain

[7] Friedrich Schiller Univ, Dept Internal Med 3, Univ Hosp Jena, Erlanger Allee 101, Jena, Germany

[8] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Oxford, England

[9] Univ Penn, Div Rheumatol, Philadelphia, PA 19104 USA

[10] Univ Penn, Dept Biostat Epidemiol & Informat, Philadelphia, PA 19104 USA

[11] Univ Cambridge, Dept Med, Cambridge CB2 0QQ, England

[12] Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England

来源：

AUTOIMMUNITY REVIEWS | 2020年 / 19卷 / 04期

关键词：

ANCA; Renal vasculitis; Kidney involvement; ANTIBODY-ASSOCIATED VASCULITIS; THROAT INVOLVEMENT; POLYANGIITIS; GRANULOMATOSIS; CLASSIFICATION; NOSE; EAR;

D O I：

10.1016/j.autrev.2020.102495

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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.

引用

页数：7

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