title: Anti-neutrophil cytoplasmic antibody-associated vasculitis with renal involvement: Analysis of 89 cases.
abstract: BACKGROUND
  The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis with renal involvement are associated with high morbi-mortality. In this study we analyse if the prognosis of these diseases have improved in recent years, and which factors influence the outcomes.
  
  
  METHODS
  Retrospective single-centre observational study, which included all patients diagnosed with microscopic polyangiitis and granulomatosis with polyangiitis with renal involvement in the last 25 years. Demographic, clinical and biochemical parameters of prognostic interest were recorded. The differences between four chronological periods were analysed, along with the determinants of a poor outcome (death or end-stage renal disease).
  
  
  RESULTS
  Eighty-nine patients were included (mean age 64±15 years). Sixty-four patients (72%) had microscopic polyangiitis and 25 (28%) granulomatosis with polyangiitis. During the study period, 37 (42%) patients died. Through Cox regression analysis, the best determinants of mortality were the initial glomerular filtration rate (HR 0.911; P=.003), Charlson comorbidity index (HR 1.513; P<.0001) and tobacco smoking (HR 1.816; P=.003). 35% developed end-stage renal disease, and the best determinants (by competing-risk regression) were: initial glomerular filtration rate (sub-hazard ratio [SHR]: 0.791; P<.0001), proteinuria (SHR: 1.313; P<.0001), and smoking status (SHR: 1.848; P=.023). No differences were found in patients' mortality or renal survival between the different study periods.
  
  
  CONCLUSIONS
  Prognosis of anti-neutrophil cytoplasm antibodies vasculitis with renal involvement treated with conventional immunosuppressive therapy remains unsatisfactory, and continues to have increased long-term complications and mortality.
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: fcaravacaf@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Caravaca-Fontán
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Estefanía
authors.initials: E
authors.lastname: Yerovi
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: María
authors.initials: M
authors.lastname: Delgado-Yagu E
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Cristina
authors.initials: C
authors.lastname: Galeano
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Saúl
authors.initials: S
authors.lastname: Pampa-Saico
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Tenorio
authors.affiliation: Servicio de Nefrología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Liaño
mesh_terms: D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
keywords: Anti-neutrophil cytoplasm antibodies; Anticuerpos contra el citoplasma de neutrófilo; Granulomatosis con poliangitis; Granulomatosis with polyangiitis; Microscopic polyangiitis; Mortalidad; Mortality; Poliangitis microscópica; Renal vasculitis; Vasculitis renal