title: Predictors for outcomes in patients with severe ANCA-associated glomerulonephritis who were dialysis-dependent at presentation: a study of 89 cases in a single Chinese center.
abstract: OBJECTIVE
  Anti-neutrophilcytoplasmic autoantibody (ANCA)-associated vasculitis may cause rapid deterioration of renal function, resulting in high prevalence of end-stage renal disease and mortality. The current study investigated factors associated with restoration of renal function and early mortality in patients with severe ANCA-associated glomerulonephritis, i.e. dialysis-dependent at presentation, in a single Chinese cohort.
  
  
  METHODS
  Eighty-nine Chinese patients with ANCA-associated glomerulonephritis who were on dialysis at the time of diagnosis were included in this study. All these patients received immunosuppressive therapy plus intravenous methylprednisolone, plasma exchange, or both. The predictive value of the clinical and histological parameters for renal and patient outcome was analyzed.
  
  
  RESULTS
  On the sixth month, 25 (28.1%) patients achieved dialysis independence, 45 (50.6%) patients progressed to end stage renal disease, and 19 (21.3%) patients died. Nine out of the 19 deaths were therapy-related. Factors independently associated with renal function restoration were percentages of normal glomeruli (P<0.05), extent of tubular atrophy (P<0.05) and extent of interstitial fibrosis (P<0.05) in the renal specimens. Age and pulmonary hemorrhage were independently associated with all-cause death (P=0.003 and P=0.007, respectively) and therapy-related death (P=0.037 and P=0.043, respectively).
  
  
  CONCLUSIONS
  Among patients with severe ANCA-associated glomerulonephritis who were dialysis-dependent at presentation, those with a higher percentage of normal glomeruli and less extent of tubular atrophy/interstitial fibrosis have more chance of restoration of renal function. Increased risk for all-cause death and therapy-related death appears to be older age and pulmonary hemorrhage.
authors: Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
authors: Zhi-Ying
authors: ZY
authors: Li
authors: Shen-Ju
authors: SJ
authors: Gou
authors: Min
authors: M
authors: Chen
authors: Ming-Hui
authors: MH
authors: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000032:analysis*; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004359:Drug Therapy, Combination; D005260:Female; D005921:Glomerulonephritis / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007166:Immunosuppressive Agents; D008775:Methylprednisolone