title: Improved outcome in anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis: a 30-year follow-up study.
abstract: BACKGROUND
  Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis has a poor prognosis. In the current study, we assessed whether prognosis in these patients improved over the last three decades.
  
  
  METHODS
  In a large inception cohort, all consecutive patients with ANCA-associated glomerulonephritis were included between January 1979 and December 2009. Inclusion criteria were the presence of ANCA and the availability of a kidney biopsy. To assess renal and patient survival, patients were divided in three groups through time: 1979-89, 1990-2000 and 2001-09.
  
  
  RESULTS
  A total of 181 patients were included. One-, 5- and 10-year survival was 77, 66 and 49%, respectively. Survival within the time groups was significantly different, yielding a hazard ratio for death of 2.9 for 1990-2000 and 3.9 for 1979-89 compared with 2001-09 (P < 0.001). Serum creatinine and active lesions as found in the kidney biopsy significantly decreased through the three decades.
  
  
  CONCLUSIONS
  Both patient and renal survival in patients with ANCA-associated renal vasculitis have improved over the last three decades. We postulate that both earlier diagnosis and better therapeutic management of patients are responsible for this effect.
authors.affiliation: Department of Internal Medicine/Division of Clinical and Experimental Immunology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Hilhorst
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wilde
authors.forename: Pieter
authors.initials: P
authors.lastname: van Paassen
authors.forename: Bjorn
authors.initials: B
authors.lastname: Winkens
authors.forename: Peter
authors.initials: P
authors.lastname: van Breda Vriesman
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Cohen Tervaert
mesh_terms: D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D001706:Biopsy; D015331:Cohort Studies; D015897:Comorbidity; D019468:Disease Management; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate