Patients with antibody-associated vasculitis can recover kidney function
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Key takeaways:
- Incidence of end-stage kidney disease for those with newly diagnosed antibody-associated vasculitis was 22% at 10 years.
- Survival rates were 2.8 times lower for those with vs. without end-stage kidney disease.
An early diagnosis of antibody-associated vasculitis may be important to long-term kidney function, study data show, as even mild forms of kidney involvement can affect prognosis.
“Kidney vasculitis is the most common severe manifestation of [antibody-associated vasculitis] AAV, typically presenting with rapidly progressive glomerulonephritis, hematuria and glomerular proteinuria,” Beatriz Sanchez-Alamo, nephrology researcher at the Department of Clinical Sciences Lund and division of nephrology at Lund University in Sweden, wrote with colleagues. “However, many patients with AAV display a ‘silent’ kidney involvement with isolated microscopic hematuria and cylindruria in the early phases.”
Researchers set out to determine long-term outcomes of patients with antineutrophil cytoplasmic AAV, define risk factors and compare histological classifications to predict outcomes for patients with the condition.
Overall, 848 patients newly with diagnosed AAV from seven randomized controlled trials between 1995 and 2012 were included in the dataset.
The 5-year and 10-year end-stage kidney disease cumulative incidence was 17% and 22%, respectively, findings showed. Patients who developed ESKD had lower survival rates vs. those with preserved kidney function, with a hazard ratio of 2.8.
Compared with matched controls without AAV, patients with AAV and kidney involvement had poor survival outcomes, even in early chronic kidney disease stages, according to the researchers. Main causes of death were infection among patients who developed ESKD and malignancy among those who did not, with cardiovascular disease also playing a role, the researchers found.
Overall, 34% of patients who initially required dialysis recovered kidney function after treatment. In addition, 35 of 175 patients who required kidney replacement therapy received a transplant with a favorable outcome and 86% survival rate at 10 years.
Researchers also used the Berden classification, renal risk score and Mayo Clinic scores in a subcohort of 214 patients with available biopsies, with the renal risk score demonstrating a moderate prediction of kidney survival and area under the curve of 0.79.
“As has been shown previously, it is important to diagnose patients with AAV early, when the kidney tissue and function are preserved,” Sanchez-Alamo and researchers wrote. “It therefore seems important to highlight the risk of ESKD among patients with AAV and to try to identify these patients at an early stage and have a kidney biopsy performed.”
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