Retrospective analysis of factors predicting end-stage renal failure or death in patients with microscopic polyangiitis with mainly renal involvement

被引:15
|
作者
Kawai, Hirohisa [1 ]
Banno, Shogo [1 ]
Kikuchi, Shogo [2 ]
Nishimura, Nahoko [1 ]
Nobata, Hironobu [1 ]
Kimura, Yukihiro [1 ]
Takezawa, Yumiko [1 ]
Ogawa, Mari [1 ]
Suzuki, Keisuke [1 ]
Kitagawa, Wataru [1 ]
Miura, Naoto [1 ]
Imai, Hirokazu [1 ]
机构
[1] Aichi Med Univ, Sch Med, Dept Internal Med, Div Nephrol & Rheumatol, Nagakute, Aichi 4801195, Japan
[2] Aichi Med Univ, Sch Med, Dept Publ Hlth, Nagakute, Aichi 4801195, Japan
关键词
Birmingham Vasculitis Activity Score; Systemic vasculitis; Microscopic polyangiitis; Rapidly progressive glomerulonephritis; Prognosis; ANTIBODY-ASSOCIATED VASCULITIS; ANCA-ASSOCIATED GLOMERULONEPHRITIS; JAPAN; MYELOPEROXIDASE; CLASSIFICATION; PATHOLOGY; PROGNOSIS; SURVIVAL; RELAPSE;
D O I
10.1007/s10157-013-0926-1
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
The aim of this study was to identify risk factors for end-stage renal failure (ESRF) or death in Japanese patients with microscopic polyangiitis (MPA) with renal involvement. From 54 consecutive patients with systemic vasculitis based on Watt's algorithm, we retrospectively analyzed 39 MPA patients with renal involvement, including 19 (48.7 %) with renal-limited vasculitis. Thirty-three of 39 patients (84.6 %) demonstrated rapidly progressive glomerulonephritis, and 13 (33.3 %) developed ESRF; 8 of 13 required dialysis within 1 week. Thirteen (33.3 %) died during follow-up of more than 12 months, and 7 died during the first 6 months, mainly because of opportunistic infections. Overall survival at 6 and 12 months was 79.5 and 71.1 %, respectively. Serum creatinine levels did not differ significantly between survivors and non-survivors (P = 0.092). The mean Birmingham Vasculitis Activity Score, version 3 (BVAS v.3), was 16.2 +/- A 6.5, with a renal subscore of over 12 points in 82.1 %, and BVAS v.3 was marginally higher in non-survivors than survivors (P = 0.045). An age- and sex-adjusted Cox proportional hazards analysis demonstrated that neither the serum creatinine level (P = 0.277) nor BVAS v.3 (P = 0.188) at initial diagnosis was a risk factor for overall survival. The baseline serum creatinine cutoff value for discriminating between ESRF and non-ESRF was 4.6 mg/dl, with a sensitivity and specificity of 92.3 and 84.6 %, respectively. Survival rates do not relate to ESRF in MPA patients with mainly renal involvement. Although patients with ESRF required regular hemodialysis, longer survival can be achieved.
引用
收藏
页码:795 / 802
页数:8
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