Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study

Booth, A. D.; Almond, Michael; Burns, Áine; Ellis, Peter; Gaskin, G.; Neild, Guy H.; Plaisance, Martin; Pusey, Charles D.; Jayne, David

doi:10.1016/s0272-6386(03)00025-8

Cited by 444 publications

(364 citation statements)

References 43 publications

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“…Both morbidity and mortality in AAV are highest in patients remaining dialysis dependent, with age .60 years and renal impairment being significant prognostic factors (14). Our cohort had 90% patient survival at 1 year, which is similar to previous studies (9) and higher than survival in the MEPEX study.…”

Section: Discussionsupporting

confidence: 87%

Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis

Pepper

Chanouzas

Tarzi

et al. 2013

Clinical Journal of the American Society of Nephrology

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Study (EUVAS) investigators SummaryBackground and objectives Induction therapy with oral cyclophosphamide (CYP) has been a mainstay of treatment in patients with severe renal failure secondary to ANCA-associated vasculitis (AAV). Recent evidence proposes using pulsed intravenous CYP in less severe disease to minimize adverse events. It is unclear if this can be translated to those with dialysis-dependent renal insufficiency.Design, setting, participants, & methods All AAV patients presenting between 2005 and 2010 requiring dialysis at presentation were retrospectively analyzed. Patients were treated with plasma exchange, corticosteroids, and intravenous CYP. Rate of dialysis independence at 3 and 12 months and adverse effects were assessed and compared with the outcome of the plasmapheresis, prednisolone, and oral CYP arm of the randomized MEPEX (methylprednisolone versus plasma exchange) trial.Results Forty-one patients were included. At 3 months, 3 (7.3%) patients had died on dialysis, 12 (29.3%) remained dialysis dependent, and 26 (63.4%) were dialysis independent (creatinine, 2.5 mg/dl; GFR, 26 ml/min per 1.73 m 2 ). Four patients subsequently reached ESRD at a median time of 83 days. Thirty-seven (90%) patients reached 1 year follow-up, 13 (35%) remained dialysis dependent, and 24 (65%) had independent renal function. Eleven patients (27%) had episodes of leukopenia (white cell count ,4310 9 /L) during CYP therapy and 17 (41%) experienced infectious complications. This compares favorably with the dialysis-dependent cohort treated with plasmapheresis in the MEPEX study in which 51% were alive with independent renal function at 1 year.Conclusions Intravenous CYP used with corticosteroids and plasmapheresis may be an effective alternative to oral CYP in patients with dialysis-dependent AAV.

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Section: Discussionsupporting

confidence: 87%

Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis

Pepper

Chanouzas

Tarzi

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…In the majority (77%) of cases, the membranous alterations were stage 1 or 2 and in 42% of cases were segmental, suggesting that MGN was detected in its early stages. The patients' outcome in our cohort appears to be worse than that of other patients with MGN and ANCAassociated NCGN reported in the literature (Table 3) and that of patients with ANCA-associated NCGN alone (24,25), with 50% reaching endpoints of death or ESRD, despite similar treatments. In our cohort, ESRD correlated with a higher serum creatinine at biopsy.…”

Section: Discussioncontrasting

confidence: 70%

Membranous Glomerulonephritis with ANCA-Associated Necrotizing and Crescentic Glomerulonephritis

Nasr¹,

Said²,

Valeri³

et al. 2009

Clinical Journal of the American Society of Nephrology

107

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“…Risk factors predictive of infections have been identified and include leukopenia, advancing age, deteriorating renal function, the intensity of cyclophosphamide, and corticosteroid therapy (3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Lymphopenia and Treatment-Related Infectious Complications in ANCA-Associated Vasculitis

Goupil

Brachemi

Nadeau‐Fredette

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives ANCA-associated vasculitis (AAV) is treated with potent immunosuppressive regimens. This study sought to determine risk factors associated with infections during first-intention therapy.Design, setting, participants, & measurements This retrospective study involved two separate cohorts of consecutive cases of AAV seen from 2004 to 2011 at two university hospitals. The following were assessed: vasculitis severity; therapy; and periods with no, moderate (lymphocyte count, 0.3-1.03 10 9 /L), or severe (lymphocyte count # 0.3310 9 /L) lymphopenia and neutropenia (neutrophil count # 1.5310 9 /L).Results One hundred patients had a mean age of 57615 years and a Birmingham vasculitis activity score of 7.763.6. Therapy consisted of pulse methylprednisolone (59%), cyclophosphamide (85%), methotrexate (6%), and plasmapheresis (25%) in addition to oral corticosteroids. During follow-up, 53% of patients experienced infection and 28% were hospitalized for infection (severe infection). Only 18% experienced neutropenia, but 72% and 36% presented moderate and severe lymphopenia for a total duration of ,0.1%, 73%, and 8% of the treatment follow-up, respectively. Lower initial estimated GFR, longer duration of corticosteroid use, and presence of lymphopenia were risk factors of infections. The rate was 2.23 events/person-year in the presence of severe lymphopenia compared with 0.41 and 0.19 during periods with moderate or no lymphopenia (P,0.001). Similarly, the rate of severe infections was 1.00 event/person-year with severe lymphopenia and 0.08 and 0.10 with moderate and no lymphopenia (P,0.001). This association remained independent of other risk factors.Conclusions Lymphopenia is frequent during the treatment of AAV, and its severity is associated with the risk of infectious complications.

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Outcome of ANCA-associated renal vasculitis: a 5-year retrospective study

Cited by 444 publications

References 43 publications

Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis

Intravenous Cyclophosphamide and Plasmapheresis in Dialysis-Dependent ANCA-Associated Vasculitis

Membranous Glomerulonephritis with ANCA-Associated Necrotizing and Crescentic Glomerulonephritis

Lymphopenia and Treatment-Related Infectious Complications in ANCA-Associated Vasculitis

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