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Outcome of ANCA-associated primary renal vasculitis in Miyazaki Prefecture
Shigehiro Uezono1, Yuji Sato, Seiichiro Hara
1Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki.
Object:
We examined the prognosis of patients with onset of new primary renal vasculitis (PRV) in Miyazaki Prefecture.
Patients And Methods:
We enrolled and followed-up 56 patients (age, 70.4 +/- 10.9 years, mean +/- SD) with onset of new PRV between January 2000 and December 2004, for a median of 24 months. Patients with PRV were defined according to the EUVAS (European Systemic Vasculitis Study Group) criteria. Outcome and factors predicting unfavorable outcome of death were examined.
Results:
Among the patients, 25% (n=14) required dialysis therapy immediately at the start of immunosuppressive therapy and of these, renal function recovered in only 3 and 6 died during the first admission. On the other hand, 75% (n=42) did not require immediate dialysis, but 8 patients were introduced to dialysis therapy thereafter. At the end of follow-up, 26 (46%) had survived without dialysis, 10 (18%) were dependent on dialysis and 20 (36%) had died. Infection was the major cause of death (n=11) . The Cox proportional hazards model showed that the presence of lung lesions and immediate dialysis therapy conferred poorer survival rates (HR, 3.32, 95% CI, 1.14 to 9.71; HR 2.73, 95% CI, 1.03 to 7.23, respectively).
Conclusion:
A poor survival rate is independently associated with the presence of lung lesions and advanced renal failure at the start of immunosuppressive therapy in patients with PRV. Half of the deaths were due to infection. Thus, PRV should be identified at an early stage and the treatment protocol should prevent infectious complications. These measures should improve the prognosis of patients with PRV.
Insights
Early detection of primary renal vasculitis (PRV) and preventing infections are key to improving patient survival. Lung lesions and advanced kidney failure at treatment start predict a poorer prognosis in PRV patients.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Primary renal vasculitis (PRV) is a serious condition affecting kidney health.
- Understanding the prognosis and risk factors for PRV is crucial for patient outcomes.
Purpose of the Study:
- To examine the prognosis of patients with new-onset primary renal vasculitis (PRV).
- To identify factors predicting unfavorable outcomes, including death, in PRV patients.
Main Methods:
- A cohort of 56 PRV patients diagnosed between 2000-2004 in Miyazaki Prefecture was followed for a median of 24 months.
- Patients were classified using European Systemic Vasculitis Study Group (EUVAS) criteria.
- Outcomes, including survival and dialysis dependency, were analyzed, with Cox proportional hazards models used to identify predictors of mortality.
Main Results:
- 46% of patients survived without dialysis, 18% required ongoing dialysis, and 36% died by the end of follow-up.
- Infection was the leading cause of death (n=11).
- Presence of lung lesions (HR 3.32) and immediate need for dialysis (HR 2.73) were independently associated with poorer survival rates.
Conclusions:
- Poor survival in PRV is linked to lung lesions and advanced renal failure at immunosuppressive therapy initiation.
- Infections account for half of PRV-related deaths, highlighting the need for preventative strategies.
- Early PRV identification and management protocols focused on preventing infectious complications are essential to improve patient prognosis.
