Andreas Kronbichler1, Jae Il Shin2, Keum Hwa Lee2, Daiki Nakagomi3, Luis F Quintana4, Martin Busch5, Anthea Craven6, Raashid A Luqmani6, Peter A Merkel7, Gert Mayer8, David R W Jayne9, Richard A Watts10. 1. Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria. Electronic address: andreas.kronbichler@i-med.ac.at. 2. Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea; Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Republic of Korea. 3. Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Third Internal Medicine, University of Yamanashi, Yamanashi, Japan. 4. Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, Barcelona, Spain. 5. Department of Internal Medicine III, University Hospital Jena - Friedrich Schiller University, Erlanger Allee 101, Jena, Germany. 6. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK. 7. Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA. 8. Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria. 9. Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Hills Road, CB2 0QQ Cambridge, United Kingdom; Department of Medicine, University of Cambridge, CB2 0QQ Cambridge, United Kingdom. 10. Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
Abstract
OBJECTIVE: Renal involvement in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis is associated with significant morbidity and higher mortality rates. This study examined clinical manifestations associated with renal involvement in ANCA-associated vasculitis within a large, international cross-sectional cohort. METHODS: Univariate and multivariate analyses were performed to identify clinical factors associated with renal disease, which was defined as i) a serum-creatinine >30% above normal and a fall in creatinine-clearance >25%; or ii) haematuria attributable to active vasculitis. RESULTS: The study cohort include 1230 patients from 31 countries; 723 (58.8%) presented with renal involvement: microscopic polyangiitis (82.2%), granulomatosis with polyangiitis (58.6%), and eosinophilic granulomatosis with polyangiitis (26.4%). The following clinical and laboratory factors were more common among patients with renal disease: age (OR 1.01, 95% CI 1.01-1.02), fever (OR 1.97, 95% CI 1.35-2.88), fatigue (OR 1.55, 95% CI 1.14-2.10), weight loss (OR 1.62, 95% CI 1.23-2.12), polyarthritis (OR 1.39, 95% CI 1.02-1.89), petechiae/purpura (OR 1.47, 95% CI 1.06-2.05), pulmonary haemorrhage (OR 5.23, 95% CI 1.39-19.63), gastrointestinal symptoms (OR 2.19, 95% CI 1.34-3.58), seizures (OR 3.42, 95% CI 1.26-9.30), lower serum albumin (OR 2.42, 95% CI 1.64-3.57), higher CRP (OR 2.06, 95% CI 1.04-4.06), low serum C3 at baseline (OR 3.86, 95% CI 1.30-11.53), myeloperoxidase- (OR 7.97, 95% CI 2.74-23.20) and proteinase 3-ANCA (OR 3.40, 95% CI 1.22-9.50). The following clinical factors were less common among patients with renal disease: mononeuritis multiplex (OR 0.63, 95% CI 0.41-0.98), proptosis/exophthalmos (OR 0.19, 95% CI 0.06-0.59), nasal polyps (OR 0.32, 95% CI 0.19-0.55), septal defect/perforation (OR 0.29, 95% CI 0.14-0.60), respiratory distress/pulmonary fibrosis/asthma (OR 0.08, 95% CI 0.04-0.19), and wheeze/obstructive airway disease (OR 0.29, 95% CI 0.16-0.52). CONCLUSION: In this large international study, several clinical and laboratory factors were identified as associated with renal involvement in ANCA-associated vasculitis.
OBJECTIVE: Renal involvement in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis is associated with significant morbidity and higher mortality rates. This study examined clinical manifestations associated with renal involvement in ANCA-associated vasculitis within a large, international cross-sectional cohort. METHODS: Univariate and multivariate analyses were performed to identify clinical factors associated with renal disease, which was defined as i) a serum-creatinine >30% above normal and a fall in creatinine-clearance >25%; or ii) haematuria attributable to active vasculitis. RESULTS: The study cohort include 1230 patients from 31 countries; 723 (58.8%) presented with renal involvement: microscopic polyangiitis (82.2%), granulomatosis with polyangiitis (58.6%), and eosinophilic granulomatosis with polyangiitis (26.4%). The following clinical and laboratory factors were more common among patients with renal disease: age (OR 1.01, 95% CI 1.01-1.02), fever (OR 1.97, 95% CI 1.35-2.88), fatigue (OR 1.55, 95% CI 1.14-2.10), weight loss (OR 1.62, 95% CI 1.23-2.12), polyarthritis (OR 1.39, 95% CI 1.02-1.89), petechiae/purpura (OR 1.47, 95% CI 1.06-2.05), pulmonary haemorrhage (OR 5.23, 95% CI 1.39-19.63), gastrointestinal symptoms (OR 2.19, 95% CI 1.34-3.58), seizures (OR 3.42, 95% CI 1.26-9.30), lower serum albumin (OR 2.42, 95% CI 1.64-3.57), higher CRP (OR 2.06, 95% CI 1.04-4.06), low serum C3 at baseline (OR 3.86, 95% CI 1.30-11.53), myeloperoxidase- (OR 7.97, 95% CI 2.74-23.20) and proteinase 3-ANCA (OR 3.40, 95% CI 1.22-9.50). The following clinical factors were less common among patients with renal disease: mononeuritis multiplex (OR 0.63, 95% CI 0.41-0.98), proptosis/exophthalmos (OR 0.19, 95% CI 0.06-0.59), nasal polyps (OR 0.32, 95% CI 0.19-0.55), septal defect/perforation (OR 0.29, 95% CI 0.14-0.60), respiratory distress/pulmonary fibrosis/asthma (OR 0.08, 95% CI 0.04-0.19), and wheeze/obstructive airway disease (OR 0.29, 95% CI 0.16-0.52). CONCLUSION: In this large international study, several clinical and laboratory factors were identified as associated with renal involvement in ANCA-associated vasculitis.
Authors: Allyson C Egan; Andreas Kronbichler; Irmgard Neumann; Alessandra Bettiol; Nicholas Carlson; Maria C Cid; Giacomo Emmi; Seerapani Gopaluni; Lorraine Harper; Thomas Hauser; Mark A Little; Raashid A Luqmani; Alfred Mahr; Mark McClure; Aladdin J Mohammad; Karl Emil Nelveg-Kristensen; Sophie Ohlsson; Chen Au Peh; Matthew Rutherford; Beatriz Sanchez Alamo; Jennifer Scott; Mårten Segelmark; Rona M Smith; Wladimir M Szpirt; Gunnar Tomasson; Giorgio Trivioli; Augusto Vaglio; Michael Walsh; Maria Wester Trejo; Kerstin Westman; Ingeborg M Bajema; David R W Jayne Journal: Kidney Int Rep Date: 2022-05-25
Authors: Helena Enocsson; Jesper Karlsson; Hai-Yun Li; Yi Wu; Irving Kushner; Jonas Wetterö; Christopher Sjöwall Journal: J Clin Med Date: 2021-12-13 Impact factor: 4.241