Impact of renal involvement on survival in ANCA-associated vasculitis.
BACKGROUND
Renal involvement is a serious complication of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV). We describe the pattern of renal involvement and its correlation with outcomes.


METHODS
Medical records of 92 patients seen in rheumatology clinic and diagnosed as AAV between January 2007 and June 2014 were analysed. Patients were classified as granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), eosinophilic granulomatosis with polyangiitis (EGPA) and undifferentiated AAV. Overall and renal outcomes were analysed. Patients were classified as advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), deranged RFT not qualifying the above parameters, and normal renal function.


RESULTS
Sixty-seven (72.8 %) patients had GPA, 14 (15.2 %) had MPA, 8 (8.7 %) had EGPA, and 3 (3.3 %) had undifferentiated AAV. Renal involvement was seen in 51 (55.4 %) patients (46.3 % of GPA patients, 78.6 % of MPA, 37.5 % of EGPA and 33.3 % of unclassifiable AAV patients). Renal involvement was more common in males (p = 0.008). Patients with renal involvement had higher mean BVAS scores as compared to patients without renal involvement (p < 0.01). Thirteen patients (25.5 %) presented with advanced renal failure (creatinine >5.7 mg/dl or requiring dialysis), 21 (41.2 %) had deranged renal functions but did not require dialysis, and the rest had proteinuria and active sediments with normal serum creatinine. Twenty-four patients (47.1 %) had good renal outcome with normal creatinine, 12 (23.5 %) had persistent renal insufficiency, 12 (23.5 %) died, and one (2 %) remained dialysis dependent. Mean survival and mortality did not differ in patients with and without renal involvement (p = 0.454, p = 0.388).


CONCLUSIONS
Renal involvement was more common in males. BVAS was higher in patients with renal involvement. The mean survival and mortality were similar in patients with or without renal involvement.
Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Manish
M
Rathi
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Benzeeta
B
Pinto
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Aadhaar
A
Dhooria
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Vinay
V
Sagar
Department of Nephrology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Tarun
T
Mittal
Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Roopa
R
Rajan
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Varun
V
Dhir
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Susheel
S
Kumar
Department of Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Kusum
K
Sharma
Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Ritambhra
R
Nada
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Surjit
S
Singh
Department of Immunopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
Ranjana Walker
RW
Minz
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. amansharma74@yahoo.com.
Aman
A
Sharma
D000293:Adolescent; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000188:drug therapy; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000188:drug therapy; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008297:Male; D055953:Microscopic Polyangiitis / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology* / Q000503:physiopathology* / Q000628:therapy; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D055815:Young Adult
D003404:Creatinine
ANCA; EGPA; GPA; India; MPA; Renal involvement