title: Risk factors associated with relapse or infectious complications in Japanese patients with microscopic polyangiitis.
abstract: BACKGROUND
  The prevention of relapse and infection complications during remission maintenance therapy is required to improve the prognosis of patients with microscopic polyangiitis (MPA) showing rapidly progressive glomerulonephritis (RPGN). The clinicopathological characteristics of patients with ANCA-positive MPA were examined to determine the risk factors for relapse or infectious complications after remission induction therapy.
  
  
  METHODS
  The study population consisted of 52 patients diagnosed as ANCA-positive MPA showing RPGN from 2002 to 2012, after publication of the Japanese guideline for RPGN. The clinicopathological findings were examined between the presence and absence of relapse or infectious complications.
  
  
  RESULTS
  The value of vasculitis damage index (VDI) was high for the relapse group and VDI value was identified as the leading factor associated with relapse [hazard ratio (HR) 3.36, 95 % confidence interval (CI) 1.58-7.12, P < 0.01]. On the other hand, the values of Birmingham Vasculitis Activity Score, clinical grade category of RPGN at diagnosis, and VDI at remission were high in the infectious group. Furthermore, clinical grade category of RPGN was the leading factor associated with infectious complications (HR 5.30, 95 % CI 1.41-19.9, P = 0.01).
  
  
  CONCLUSIONS
  The disease activity at diagnosis and severity of organ damage at remission were associated with relapse and infectious complications during remission maintenance therapy and infectious complication affected kidney survival and all-cause mortality in patients with ANCA-positive MPA exhibiting RPGN.
authors.affiliation: Division of Internal Medicine, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors.forename: Kiyoki
authors.initials: K
authors.lastname: Kitagawa
authors.affiliation: Division of Blood Purification, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. kfuruichi@m-kanazawa.jp.|Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan. kfuruichi@m-kanazawa.jp.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan. kfuruichi@m-kanazawa.jp.
authors.forename: Kengo
authors.initials: K
authors.lastname: Furuichi
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sagara
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shinozaki
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kitajima
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Toyama
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Hara
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.|Department of Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Iwata
authors.affiliation: Division of Blood Purification, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.|Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Shimizu
authors.affiliation: Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.affiliation: Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan.|Department of Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Wada
mesh_terms: D000368:Aged; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D005260:Female; D005921:Glomerulonephritis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Infection; Microscopic polyangiitis (MPA); Prognosis; Rapidly progressive glomerulonephritis (RPGN); Relapse