Characteristics and prognosis of acute renal failure on dialysis in ANCA vasculitis

Azria Siham, Fessi Hafedh, Boffa Jean-Jacques, Michel Pierre-Antoine
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Abstract

Renal involvement in ANCA (Anti Neutrophil Cytoplasmic Antigen) vasculitis is common and is associated with increased mortality with a significant risk of progression to end-stage renal disease. The aim of this study is to investigate the epidemiological, clinicopathological, therapeutic and evolutionary characteristics of patients with ANCA vasculitis with acute renal injury, and to evaluate the impact of haemodialysis in the acute phase on mortality and renal recovery. Secondary objectives are to investigate other risk factors that impact on overall and renal survival. 31 patients were included ; the mean follow-up time was 30 months. The mean age was 68.52 years, and the sex ratio 0.72. All patients had acute renal failure, with histology revealing a mixed form in 45% of cases and a sclerotic form in 12.9% of cases. Pulmonary involvement was found in 58% of cases. 71% of patients had ANCA with anti-myeloperoxydase specificity, and 25.8% anti-proteinase 3 specificity. 32.2% of patients required haemodialysis, of which 60% were weaned. As initial treatment, 58.1% of patients received cyclophosphamide and 35.5% rituximab. The relapse rate was 6.5%. Infectious and cardiovascular complications affected more than half of the patients. The mortality rate was 19.35%. Comparing the two groups of patients dialysed in the acute phase and not dialysed, it appears that the overall and renal mortality was comparable. The progression to end-stage renal failure was higher in the dialysis patients. In a multivariate study, the presence of chronic kidney disease in the history and pulmonary involvement were associated with higher mortality.

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ANCA 血管炎患者急性肾衰竭透析治疗的特点和预后
ANCA(抗中性粒细胞胞浆抗原)血管炎的肾脏受累很常见,与死亡率升高有关,并有发展为终末期肾病的显著风险。本研究旨在调查伴有急性肾损伤的 ANCA 血管炎患者的流行病学、临床病理学、治疗和演变特征,并评估急性期血液透析对死亡率和肾功能恢复的影响。次要目标是调查影响总体存活率和肾脏存活率的其他风险因素。共纳入 31 名患者,平均随访时间为 30 个月。平均年龄为 68.52 岁,性别比为 0.72。所有患者均出现急性肾功能衰竭,组织学显示 45% 的病例为混合型,12.9% 的病例为硬化型。58%的患者肺部受累。71%的患者有抗骨髓过氧化物酶特异性 ANCA,25.8%的患者有抗蛋白酶 3 特异性 ANCA。32.2%的患者需要进行血液透析,其中60%的患者已经断血。作为初始治疗,58.1%的患者接受了环磷酰胺治疗,35.5%接受了利妥昔单抗治疗。复发率为 6.5%。半数以上患者出现感染和心血管并发症。死亡率为 19.35%。比较急性期透析和未透析的两组患者,总体死亡率和肾脏死亡率似乎相当。透析患者发展为终末期肾衰竭的几率更高。在一项多变量研究中,病史中存在慢性肾病和肺部受累与较高的死亡率有关。
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