title: ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse.
abstract: Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild-moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray's regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8-14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray's model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different.
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Arda
authors.initials: A
authors.lastname: Göçeroğlu
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Annelies E
authors.initials: AE
authors.lastname: Berden
authors.affiliation: Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Netherlands.|Institute of Mathematics, Leiden University, Leiden, Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: Fiocco
authors.affiliation: Renal Unit, Royal Berkshire Hospital, Reading, United Kingdom.
authors.forename: Oliver
authors.initials: O
authors.lastname: Floßmann
authors.affiliation: Department of Nephrology, University Hospital Malmö, Malmö, Sweden.
authors.forename: Kerstin W
authors.initials: KW
authors.lastname: Westman
authors.affiliation: Nephropathology Center, San Gerardo Hospital, Monza, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Ferrario
authors.affiliation: Department of Renal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Gill
authors.initials: G
authors.lastname: Gaskin
authors.affiliation: Department of Renal Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Pusey
authors.affiliation: Department of Nephrology, Meander Medical Center, Amersfoort, Netherlands.
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Hagen
authors.affiliation: Department of Pathology, Necker Hospital, René Descartes University, Paris, France.
authors.forename: Laure-Hélène
authors.initials: LH
authors.lastname: Noël
authors.affiliation: Department of Autoimmune Serology, Statens Seruminstitut, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Rasmussen
authors.affiliation: Department of Pathology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Waldherr
authors.affiliation: Department of Medicine (Nephrology), St Joseph's Hospital, McMaster University, Hamilton, Canada.|Department of Clinical Epidemiology & Biostatistics, St Joseph's Hospital, McMaster University, Hamilton, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Bruijn
authors.affiliation: Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: David R W
authors.initials: DR
authors.lastname: Jayne
authors.affiliation: Department of Pathology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Ingeborg M
authors.initials: IM
authors.lastname: Bajema
mesh_terms: D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000175:diagnosis* / Q000453:epidemiology; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000737:chemistry*; D002908:Chronic Disease; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic