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ANCA-associated glomerulonephritis: risk factors for renal relapse

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ANCA-Associated Glomerulonephritis: Risk Factors for Renal Relapse.pdfPublished version904.29 kBAdobe PDFView/Open
Title: ANCA-associated glomerulonephritis: risk factors for renal relapse
Authors: Goceroglu, A
Berden, AE
Fiocco, M
Flossmann, O
Westman, KW
Ferrario, F
Gaskin, G
Pusey, CD
Hagen, EC
Noel, L-H
Rasmussen, N
Waldherr, R
Walsh, M
Bruijn, JA
Jayne, DRW
Bajema, IM
Item Type: Journal Article
Abstract: Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild–moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray’s regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8–14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray’s model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different.
Issue Date: 14-Dec-2016
Date of Acceptance: 11-Oct-2016
URI: http://hdl.handle.net/10044/1/78774
DOI: 10.1371/journal.pone.0165402
ISSN: 1932-6203
Publisher: Public Library of Science (PLoS)
Journal / Book Title: PLoS One
Volume: 11
Issue: 12
Copyright Statement: © 2016 Göçeroğlu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: NF-SI-0611-10055
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
SMALL-VESSEL VASCULITIS
ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODIES
SYSTEMIC VASCULITIS
COMPETING RISKS
MICROSCOPIC POLYANGIITIS
WEGENERS-GRANULOMATOSIS
TREATMENT RESISTANCE
MULTISTATE MODELS
RANDOMIZED-TRIAL
PREDICTORS
Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Antibodies, Antineutrophil Cytoplasmic
Chronic Disease
Europe
Female
Follow-Up Studies
Glomerular Filtration Rate
Glomerulonephritis
Humans
Incidence
Kidney
Kidney Failure, Chronic
Male
Middle Aged
Proportional Hazards Models
Recurrence
Regression Analysis
Risk Factors
Treatment Outcome
European Vasculitis Society (EUVAS)
Kidney
Humans
Kidney Failure, Chronic
Glomerulonephritis
Chronic Disease
Recurrence
Antibodies, Antineutrophil Cytoplasmic
Glomerular Filtration Rate
Treatment Outcome
Incidence
Proportional Hazards Models
Risk Factors
Regression Analysis
Follow-Up Studies
Aged
Middle Aged
Europe
Female
Male
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
SMALL-VESSEL VASCULITIS
ANTINEUTROPHIL CYTOPLASMIC AUTOANTIBODIES
SYSTEMIC VASCULITIS
COMPETING RISKS
MICROSCOPIC POLYANGIITIS
WEGENERS-GRANULOMATOSIS
TREATMENT RESISTANCE
MULTISTATE MODELS
RANDOMIZED-TRIAL
PREDICTORS
General Science & Technology
Publication Status: Published
Article Number: ARTN e0165402
Appears in Collections:Department of Immunology and Inflammation