CLINICAL ASSOCIATIONS OF RENAL INVOLVEMENT IN ANCA-ASSOCIATED VASCULITIS
- Andreas Kronbichler, Austria
Abstract
Background and Aims
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 (p=0.001), fever (p<0.001), fatigue (p=0.005), weight loss (p=0.001), polyarthritis (p=0.036), petechiae/purpura (p=0.022), pulmonary haemorrhage (p=0.014), gastrointestinal symptoms (p=0.002), seizures (p=0.016), lower serum albumin (p<0.001), higher CRP (p=0.038), low serum C3 at baseline (p=0.015), myeloperoxidase- (p<0.001) and proteinase 3-ANCA (p=0.020). The following clinical factors were less common among patients with renal disease: mononeuritis multiplex (p=0.041), proptosis/exophthalmos (p=0.001), nasal polyps, septal defect/perforation (p<0.001 each), respiratory distress/pulmonary fibrosis/asthma (p<0.001), and wheeze/obstructive airway disease (p<0.001).
Conclusions
In this large international study, several clinical and laboratory factors were identified as associated with renal involvement in ANCA-associated vasculitis.