Kiyoki Kitagawa1, Kengo Furuichi2,3,4, Akihiro Sagara5,6, Yasuyuki Shinozaki5,6, Shinji Kitajima5,6, Tadashi Toyama5,6, Akinori Hara5,6, Yasunori Iwata5,6,7, Norihiko Sakai8,5,6, Miho Shimizu5,6, Shuichi Kaneko6, Takashi Wada5,7. 1. Division of Internal Medicine, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan. 2. Division of Blood Purification, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. kfuruichi@m-kanazawa.jp. 3. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan. kfuruichi@m-kanazawa.jp. 4. Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan. kfuruichi@m-kanazawa.jp. 5. Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan. 6. Department of Disease Control and Homeostasis, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan. 7. Department of Laboratory Medicine, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Science, Kanazawa University, Kanazawa, Japan. 8. Division of Blood Purification, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
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. PATIENTS AND 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). CONCLUSION: 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.
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. PATIENTS AND 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). CONCLUSION: 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: C Mukhtyar; L Guillevin; M C Cid; B Dasgupta; K de Groot; W Gross; T Hauser; B Hellmich; D Jayne; C G M Kallenberg; P A Merkel; H Raspe; C Salvarani; D G I Scott; C Stegeman; R Watts; K Westman; J Witter; H Yazici; R Luqmani Journal: Ann Rheum Dis Date: 2008-04-15 Impact factor: 19.103
Authors: C Lapraik; R Watts; P Bacon; D Carruthers; K Chakravarty; D D'Cruz; L Guillevin; L Harper; D Jayne; R Luqmani; J Mooney; D Scott Journal: Rheumatology (Oxford) Date: 2007-09-05 Impact factor: 7.580