title: Renal vasculitis presenting with acute kidney injury.
abstract: Renal failure secondary to ANCA-associated vasculitis represents a clinical and therapeutic challenge. In this study, we aimed to assess the treatment response rates and long-term outcomes of vasculitis patients presenting with renal failure. This retrospective study included 151 patients with renal vasculitis from three hospitals who underwent a renal biopsy between 1997 and 2014. Patients with renal failure which required dialysis at the onset were compared to those presenting with more preserved renal function. The primary end point was treatment response and patient surivival. Patients with severe renal involvement had a lower response to treatment compared to those having preserved renal function (26.6 versus 93.4%; p < 0.001). Dialysis-dependent patients who received plasmapheresis in addition to immune suppressants associated a higher rate of renal recovery (41.6 versus 12.5%; p = 0.05). A higher incidence of severe infections was observed among patients with severe renal involvement (38.4 versus 18.1%, p = 0.01). The mortality rate was significantly higher among vasculitis patients presenting with renal failure (53.8 versus 22.2%, p = 0.001). Global survival at 1 and 5 years was 60 and 47% in patients requiring dialysis compared with 90 and 80% among those with more preserved renal function (p < 0.001). After multivariate adjustment, the need for dialysis remained as an independent predictor of death (HR 2.5; 95% CI 1.1-5.7; p = 0.03). The presence of severe renal dysfunction represents an independent risk factor for patient survival in renal vasculitis. Patients requiring dialysis associate a lower response rate to immunosuppressive therapy and a higher incidence of severe infections.
authors.affiliation: Nephrology Department, Hospital Universitario Fundacion, C/Budapest 1, Alcorcon, 28922, Comunidad De Madrid, Spain. jvillacorta@fhalcorcon.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Villacorta
authors.affiliation: Pathology Department, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Diaz-Crespo
authors.affiliation: Nephrology Department, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Acevedo
authors.affiliation: Nephrology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cavero
authors.affiliation: Pathology Department, Hospital Universitario Fundacion Alcorcon, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerrero
authors.affiliation: Nephrology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.affiliation: Nephrology Department, Hospital Universitario Fundacion, C/Budapest 1, Alcorcon, 28922, Comunidad De Madrid, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Fernandez-Juarez
mesh_terms: D058186:Acute Kidney Injury / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001706:Biopsy; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000276:immunology / Q000473:pathology / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051437:Renal Insufficiency / Q000276:immunology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: ANCA; Glomerulonephritis; Vasculitis