Clinical outcomes of Japanese MPO-ANCA-related nephritis: Significance of initial renal death for survival

Kimio Watanabe, Yoshihiro Tani, Hiroshi Kimura, Kenichi Tanaka, Yoshimitsu Hayashi, Koichi Asahi, Keiji Sato, Mamoru Sato, Masato Matsushima, Masaaki Nakayama, Tsuyoshi Watanabe

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Objective Anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)- related nephritis constitutes 60% of rapidly progressive glomerulonephritis (RPGN) in Japan. The reported 1-year survival rate is over 80%, however, the long-term prognosis remains unknown. We therefore investigated the prognosis and factors affecting the clinical course of patients. Methods We retrospectively investigated 74 patients (female, n=42; median age, 73.0 years) with MPOANCA- related nephritis. The patients were admitted to Fukushima Medical University and two afiliated hospitals between 2000 and 2010. Results Median estimated GFR (eGFR) was 12.1 mL/min/1.73 m2 at admission. The Birmingham Vasculitis Activity Score (BVAS version 3: max 63 points) at diagnosis and at 4 weeks after start of treatment were 15.0 and 5.0, respectively. Twenty-three patients (31%) died during a median observation period of 30.5 months. Sixteen patients (22%) presented with end-stage renal disease (ESRD) at the initial phase, and needed regular dialysis therapy. Multivariate Cox proportional hazards model analysis revealed that renal death at the initial phase was a significant risk factor for all-cause death (Hazard ratio, 5.72; 95% confidence interval, 2.49-13.09; p<0.001). Furthermore, BVAS>6, evaluated 4 weeks after start of treatment, is an independent risk factor for ESRD and patient survival. Conclusion This is the first investigation to demonstrate clinical features focusing on MPO-ANCA-related nephritis. Renal death at the initial phase of treatment is a powerful risk factor for all-cause death in patients with MPO-ANCA-related nephritis. Patients at high risk of death and ESRD could be stratified according to BVAS.

Original languageEnglish
Pages (from-to)1969-1976
Number of pages8
JournalInternal Medicine
Volume51
Issue number15
DOIs
Publication statusPublished - 2012

Keywords

  • Anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-related nephritis
  • Japanese
  • Microscopic polyangitis (MPA)
  • Rapidly progressive glomerulonephritis (rpgn)
  • The birmingham vasculitis activity score (BVAS)

ASJC Scopus subject areas

  • Internal Medicine

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