Clinical prognostic factors of renal outcome in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis in elderly patients

Kaplan-Pavlovčič, Staša

doi:10.1093/ndt/gfg1033

Cited by 38 publications

(29 citation statements)

References 11 publications

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“…Our results extend the observations from the Dutch cohort. Our data are also in agreement with published results from other studies, showing that the renal function at initial presentation is the best predictor for renal function at follow-up (27)(28)(29). However, in contrast to the Dutch study, no significant correlation with the relapse risk was found in our cohort.…”

Section: Discussionsupporting

confidence: 92%

Membrane Proteinase 3 Expression in Patients with Wegener’s Granulomatosis and in Human Hematopoietic Stem Cell–Derived Neutrophils

Schreiber

Otto

et al. 2005

Journal of the American Society of Nephrology

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A large membrane proteinase 3 (mPR3)-positive neutrophil subset (mPR3 high ) is a risk for Wegener's granulomatosis (WG).The relationship between mPR3 expression and clinical manifestations was investigated in 81 WG patients and mPR3 expression was studied in CD34 ؉ stem cell-derived human neutrophils. The mPR3 high neutrophil percentage correlated with renal function, anemia, and albumin at the time of presentation. The mPR3 high neutrophil percentage and renal failure severity correlated directly after 5 yr. For elucidating mechanisms that govern mPR3 expression, studies were conducted to determine whether the genetic information that governs mPR3 expression resides within the neutrophils, even without stimuli possibly related to disease. CD34 ؉ hematopoietic stem cells were differentiated to neutrophils, and their mPR3 expression was determined. A two-step amplification/differentiation protocol was used to differentiate human CD34 ؉ hematopoietic stem cells into neutrophils with G-CSF. The cells progressively expressed the neutrophil surface markers CD66b, CD35, and CD11b. The ferricytochrome C assay demonstrated a strong respiratory burst at day 14 in response to PMA but none at day 0. Intracellular PR3 was detectable from day 4 by Western blotting. An increasing percentage of a mPR3-positive neutrophil subset became detectable by flow cytometry, whereas a second subset remained negative, consistent with a bimodal expression. Finally, human PR3-anti-neutrophil cytoplasmic autoantibodies induced a stronger respiratory burst, compared with human control IgG in stem cell-derived neutrophils. Taken together, these studies underscore the clinical importance of the WG mPR3 phenotype. The surface mPR3 on resting cells is probably genetically determined rather than being dictated by external factors.

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Section: Discussionsupporting

confidence: 92%

Membrane Proteinase 3 Expression in Patients with Wegener’s Granulomatosis and in Human Hematopoietic Stem Cell–Derived Neutrophils

Schreiber

Otto

et al. 2005

Journal of the American Society of Nephrology

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“…High creatinine at presentation is a well known risk factor for impaired renal survival (2,12,17,28,29), and we confirmed this in older patients. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis, and treatment with immunosuppressive agents was not significantly associated with renal survival.…”

Section: Discussionsupporting

confidence: 80%

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Weiner¹,

Goh

Mohammad

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives ANCA-associated vasculitis is commonly found in elderly patients, but there are few data concerning outcome and treatment in the highest age groups.Design, setting, participants, & measurements Consecutive patients (N=151) presenting between 1997 and 2009 were retrospectively included from local registries in six centers in Sweden, the United Kingdom, and the Czech Republic if diagnosed with microscopic polyangiitis or granulomatosis with polyangiitis at age $75 years during the study period. Patients were followed until 2 years from diagnosis or death. Data on survival and renal function were analyzed with respect to age, sex, ANCA specificity, renal function, C-reactive protein, comorbidities, and Birmingham Vasculitis Activity Score at diagnosis as well as treatment during the first month.Results Median follow-up was 730 days (interquartile range, 244-730). Overall 1-year survival was 71.5% and 2-year survival was 64.6%. Older age, higher creatinine, and lower Birmingham Vasculitis Activity Score were associated with higher mortality in multivariable analysis. Patients who were not treated with standard immunosuppressive therapy had significantly worse survival. Renal survival was 74.8% at 1 year. No new cases of ESRD occurred during the second year. High creatinine at diagnosis was the only significant predictor of renal survival in multivariable analysis.Conclusions ANCA-associated vasculitis is a disease with substantial mortality and morbidity among elderly patients. This study showed a better prognosis for those who received immunosuppressive treatment and those who were diagnosed before having developed advanced renal insufficiency.

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“…This could be because a high ratio of our patients was elderly and dialysis-dependent. As in other recently published series (10,(19)(20)(21) showing that the age of patients with ANCA-associated vasculitis is increasing, the median age of our patients was 72 years and 63% were aged 70 years or older. The 2-year mortality rate of 36% among our patients was similar to the findings of others (9-13) with an older population and severe renal impairment, highlighting the importance of age and renal function for survival.…”

Section: F I G U R E 2 Ka P L a N -Me I E R P L O T I N D I C A T Isupporting

confidence: 83%

Outcome of ANCA-Associated Primary Renal Vasculitis in Miyazaki Prefecture

et al. 2007

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Object We examined the prognosis of patients with onset of new primary renal vasculitis (PRV) in Miyazaki Prefecture.Patients and Methods We enrolled and followed-up 56 patients (age, 70.4 ± 10.9 years, mean ± SD) (HR, 3.32, 95% CI, 1.14 to 9.71; HR 2.73, 95% CI, 1.03 to 7.23, respectively Results Among the patients, 25% (n=14) required dialysis therapy immediately at the start of immunosuppressive therapy and of these, renal function recovered in only 3 and 6 died during the first admission. On the other hand, 75% (n=42) did not require immediate dialysis, but 8 patients were introduced to dialysis therapy thereafter. At the end of follow-up, 26 (46%) had survived without dialysis, 10 (18%) were dependent on dialysis and 20 (36%) had died. Infection was the major cause of death (n=11) . The Cox proportional hazards model showed that the presence of lung lesions and immediate dialysis therapy conferred poorer survival rates

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Clinical prognostic factors of renal outcome in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated glomerulonephritis in elderly patients

Abstract: The actuarial renal survival rate in elderly patients with ANCA-associated GN was 92% at 1 year and 76% at 3 years. Older age, arterial hypertension, proteinuria and serum creatinine > or =400 micro mol/l related to ESRD.

Cited by 38 publications

References 11 publications

Membrane Proteinase 3 Expression in Patients with Wegener’s Granulomatosis and in Human Hematopoietic Stem Cell–Derived Neutrophils

Membrane Proteinase 3 Expression in Patients with Wegener’s Granulomatosis and in Human Hematopoietic Stem Cell–Derived Neutrophils

Outcome and Treatment of Elderly Patients with ANCA-Associated Vasculitis

Outcome of ANCA-Associated Primary Renal Vasculitis in Miyazaki Prefecture

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