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Improved prognosis of renal microscopic polyarteritis in recent years
G Fuiano1, J S Cameron, M Raftery
1Renal Unit, Guy's Hospital, London, UK.
Abstract:
To determine if the short- and long-term prognosis of renal micropolyarteritis (including Wegener's granulomatosis) had improved in our Unit in the last 5 years compared to our previous series from 1965 to 1980, we examined data from 26 recent patients, 1981-1986. Twenty were admitted during acute phase and six after a mean of 7.1 months of disease. The acute phase showed mild to severe impairment of renal function, and renal biopsies showed necrotising glomerulitis in all acute patients with extensive crescents in 67%. Acute patients (20) were treated with 'aggressive' immunosuppression including i.v. methylprednisolone (15), plasmapheresis (seven) and cyclophosphamide (ten). Chronic immunosuppressive treatment was continued in most patients. In the 20 acute-onset patients, life survival at 2 and 5 years was 77%; four of five deaths occurred during the acute phase in aged patients with severe renal failure. The notable improvement in life and kidney survival (only one patient underwent chronic dialysis) probably resulted from greater awareness of vasculitis in general practice with early referral of patients to specialised units, and to more aggressive treatment.
Insights
Prognosis for renal micropolyarteritis, including Wegener's granulomatosis, has improved due to earlier diagnosis and aggressive immunosuppression. This leads to better outcomes for patients with this rare autoimmune disease.
Area of Science:
- Nephrology
- Rheumatology
- Immunology
Background:
- Renal micropolyarteritis, including Wegener's granulomatosis, is a serious autoimmune condition affecting the kidneys.
- Previous treatment strategies had limited success in improving patient prognosis.
- Evaluating recent outcomes is crucial for understanding treatment advancements.
Purpose of the Study:
- To compare the short- and long-term prognosis of renal micropolyarteritis in a recent 5-year period (1981-1986) with historical data (1965-1980).
- To assess the impact of current treatment protocols on patient survival and renal function.
Main Methods:
- Retrospective analysis of 26 patients diagnosed with renal micropolyarteritis between 1981 and 1986.
- Review of patient data including renal function, biopsy results, and treatment regimens.
- Comparison of survival rates and renal outcomes with a previous patient cohort.
Main Results:
- Seventy-seven percent of acute-onset patients survived 2 and 5 years, a significant improvement.
- Only one patient required chronic dialysis, indicating preserved kidney function.
- Aggressive immunosuppression, including methylprednisolone, plasmapheresis, and cyclophosphamide, was employed.
Conclusions:
- Improved awareness and early referral have enhanced the prognosis of renal micropolyarteritis.
- Aggressive immunosuppressive therapy contributes to better life and kidney survival rates.
- The findings suggest a positive shift in managing this vasculitic condition.