Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Kidney Injury: Short-Term Recovery Predicts Long-Term Outcome

Abstract

BackgroundKidney involvement is common in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It tends to be aggressive, and in some patients, the kidney involvement may reach the criteria of acute kidney injury (AKI). Here, we aim to describe the clinical characteristics of these patients and find risk factors for poor outcomes.MethodsPatients diagnosed with AAV in our hospital from February 2003 to February 2017 were included. Those who reached the KDIGO AKI criteria were reclassified according to the KDIGO AKI stage. The clinical features of these patients were analyzed. Also, according to the variation of serum creatinine 3 months after AKI episode, patients were further divided into two groups: patients whose serum creatinine (Scr) level at the third month decreased by 30% or more from the peak Scr level was classified into G1 and others were classified into G2. Long-term renal and survival outcomes of these patients were analyzed with a Cox model. The renal endpoint was reaching end-stage renal disease (ESRD), and the survival endpoint was death. Nomograms were built based on cox models.ResultsOf 141 AAV patients included, during the median follow-up period of 64.0 (IQR 34.8, 85.4) months, 36 (25.5%) patients reached renal endpoints, and 22 (15.6%) patients died. The median renal survival time was 35.9 (IQR 21.3, 72.6) months and the median survival time was 48.4 (IQR 26.8, 82.8) months. Multivariate analysis showed that poor recovery of Scr level at 90 days (P < 0.001, RR = 9.150, 95%CI 4.163–20.113), BVAS score (P = 0.014, RR = 1.110, 95% CI1.021–1.207), and AKI stage 3 (P = 0.012 RR = 3.116, 95%CI 1.278–7.598) were independent risk factors for renal endpoints; poor recovery of Scr level at 90 days (P = 0.010, RR = 3.264, 95%CI 1.326–8.035), BVAS score (P = 0.010, RR = 1.171, 95%CI 1.038–1.320) and age (P = 0.017, RR = 1.046, 95%CI 1.008–1.086) were independent risk factors for all-cause death. The c-index of nomograms is 0.830 for the renal outcome and 0.763 for the survival outcome.ConclusionKDIGO AKI stage 3 is the risk factor for ESRD in AAV patients with AKI. The BVAS score and level of kidney function recovery at 90 days are the independent risk factors for both ESRD and all-cause death and are of predictive value for the outcome.

Association between computed tomography‐assessed sarcopenia and mortality in patients with anti‐neutrophil cytoplasmic antibody‐associated vasculitis

“…These differences could be related to the fact that weight loss, which is also a sign of frailty, is a component included in the general manifestation of Birmingham Vasculitis Activity Score and renal involvement is one of the most life-threatening complications of AAV. 41,42 Our study identified that there is a relationship between sarco- inexpensive tests and have been shown to predict poor outcomes in various populations. 43 Hence, it would be of importance to develop practical measures for assessing sarcopenia besides NAMA/ TAMA ratio, that could aid in identifying AAV patients at greater risk of adverse outcomes.…”

“…Our results found that NAMA/TAMA differed in those showing the clinical features of general and renal manifestation compared with those without these features. These differences could be related to the fact that weight loss, which is also a sign of frailty, is a component included in the general manifestation of Birmingham Vasculitis Activity Score and renal involvement is one of the most life‐threatening complications of AAV 41,42 …”

Glomerulonephritis as a renal manifestation in a patient with systemic sclerosis overlapped with anti-neutrophil cytoplasmic antibody-associated vasculitis

“…Kidney involvement is common and main manifestation of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presented as glomerulonephritis in the disease course [7] . We reported a case of a 28-year-old male patient with comorbid SSc and AAV.…”