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Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis
INTRODUCTION: Studies in antineutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (AAV) consistently show that the months following diagnosis have the greatest impact on the long-term renal function. Yet, it remains uncertain how much early gain should be expected with treatment. We soug...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451086/ https://www.ncbi.nlm.nih.gov/pubmed/30993234 http://dx.doi.org/10.1016/j.ekir.2019.02.005 |
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author | Lepeytre, Fanny Royal, Virginie Lavoie, Pierre-Luc Bollée, Guillaume Gougeon, François Beauchemin, Stéphanie Rhéaume, Maxime Brachemi, Soumeya Laurin, Louis-Philippe Troyanov, Stéphan |
author_facet | Lepeytre, Fanny Royal, Virginie Lavoie, Pierre-Luc Bollée, Guillaume Gougeon, François Beauchemin, Stéphanie Rhéaume, Maxime Brachemi, Soumeya Laurin, Louis-Philippe Troyanov, Stéphan |
author_sort | Lepeytre, Fanny |
collection | PubMed |
description | INTRODUCTION: Studies in antineutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (AAV) consistently show that the months following diagnosis have the greatest impact on the long-term renal function. Yet, it remains uncertain how much early gain should be expected with treatment. We sought to determine the factors associated with the change in glomerular filtration rate (GFR) throughout the first year. METHODS: We retrospectively reviewed patients from 3 university hospitals who received treatments. We assessed the proportions of glomeruli with crescents, with global sclerosis, the AAV glomerulonephritis classification, the severity of chronic vascular and tubulo-interstitial disease, and the presence of acute tubular injury (ATI). We used repeated-measures analyses of variance (ANOVAs) to determine factors associated with the change in GFR throughout the first year. RESULTS: There were 162 individuals with AAV identified, 96 with a valid renal biopsy and 82 with at least 12 months of follow-up. The initial GFR of 30 ± 25 ml/min per 1.73 m(2) rose by 15 ± 20 during the first year. The severity of pathology findings, myeloperoxidase positivity, and those with kidney- and lung-limited disease presented with a lower GFR. Younger patients with a lower initial GFR and the presence of ATI correlated with a greater increase in GFR by 12 months. A higher proportion of crescents did not predict the change in GFR, contrary to global glomerulosclerosis, where each 10% increase added a loss of 2.7 ± 1.3 ml/min per 1.73 m(2) per year (P = 0.03). These factors remained independent of each other. CONCLUSION: Multiple factors influence renal recovery during the first year of therapy. Estimating the change in GFR early on will help identify and reassess outliers. |
format | Online Article Text |
id | pubmed-6451086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-64510862019-04-16 Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis Lepeytre, Fanny Royal, Virginie Lavoie, Pierre-Luc Bollée, Guillaume Gougeon, François Beauchemin, Stéphanie Rhéaume, Maxime Brachemi, Soumeya Laurin, Louis-Philippe Troyanov, Stéphan Kidney Int Rep Clinical Research INTRODUCTION: Studies in antineutrophil cytoplasmic autoantibody (ANCA)–associated vasculitis (AAV) consistently show that the months following diagnosis have the greatest impact on the long-term renal function. Yet, it remains uncertain how much early gain should be expected with treatment. We sought to determine the factors associated with the change in glomerular filtration rate (GFR) throughout the first year. METHODS: We retrospectively reviewed patients from 3 university hospitals who received treatments. We assessed the proportions of glomeruli with crescents, with global sclerosis, the AAV glomerulonephritis classification, the severity of chronic vascular and tubulo-interstitial disease, and the presence of acute tubular injury (ATI). We used repeated-measures analyses of variance (ANOVAs) to determine factors associated with the change in GFR throughout the first year. RESULTS: There were 162 individuals with AAV identified, 96 with a valid renal biopsy and 82 with at least 12 months of follow-up. The initial GFR of 30 ± 25 ml/min per 1.73 m(2) rose by 15 ± 20 during the first year. The severity of pathology findings, myeloperoxidase positivity, and those with kidney- and lung-limited disease presented with a lower GFR. Younger patients with a lower initial GFR and the presence of ATI correlated with a greater increase in GFR by 12 months. A higher proportion of crescents did not predict the change in GFR, contrary to global glomerulosclerosis, where each 10% increase added a loss of 2.7 ± 1.3 ml/min per 1.73 m(2) per year (P = 0.03). These factors remained independent of each other. CONCLUSION: Multiple factors influence renal recovery during the first year of therapy. Estimating the change in GFR early on will help identify and reassess outliers. Elsevier 2019-02-13 /pmc/articles/PMC6451086/ /pubmed/30993234 http://dx.doi.org/10.1016/j.ekir.2019.02.005 Text en © 2019 International Society of Nephrology. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Clinical Research Lepeytre, Fanny Royal, Virginie Lavoie, Pierre-Luc Bollée, Guillaume Gougeon, François Beauchemin, Stéphanie Rhéaume, Maxime Brachemi, Soumeya Laurin, Louis-Philippe Troyanov, Stéphan Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title | Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title_full | Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title_fullStr | Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title_full_unstemmed | Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title_short | Estimating the Change in Renal Function During the First Year of Therapy in ANCA-Associated Vasculitis |
title_sort | estimating the change in renal function during the first year of therapy in anca-associated vasculitis |
topic | Clinical Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451086/ https://www.ncbi.nlm.nih.gov/pubmed/30993234 http://dx.doi.org/10.1016/j.ekir.2019.02.005 |
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