ANCA-associated glomerulonephritis: Risk factors for renal relapse

Research output: Contribution to journalArticle

Abstract

Relapse in ANCA-associated vasculitis (AAV) has been studied previously, but there are few studies on renal relapse in particular. Identifying patients at high risk of renal relapse may aid in optimizing clinical management. We investigated which clinical and histological parameters are risk factors for renal relapse in ANCA-associated glomerulonephritis (AAGN). Patients (n = 174) were newly diagnosed and had mild±moderate or severe renal involvement. Data were derived from two trials of the European Vasculitis Society: MEPEX and CYCAZAREM. The Cox regression model was used to identify parameters increasing the instantaneous risk (= rate) of renal relapse (useful for instant clinical decisions). For identifying predictors of renal relapse during follow-up, we used Fine & Gray's regression model. Competing events were end-stage renal failure and death. The cumulative incidence of renal relapse at 5 years was 9.5% (95% CI: 4.8±14.3%). In the Cox model, sclerotic class AAGN increased the instantaneous risk of renal relapse. In Fine & Gray's model, the absence of interstitial infiltrates at diagnosis was predictive for renal relapse. In this study we used two different models to identify possible relationships between clinical and histopathological parameters at time of diagnosis of AAV with the risk of experiencing renal relapse. Sclerotic class AAGN increased the instantaneous risk of renal relapse. This association is most likely due to the high proportion of sclerosed glomeruli reducing the compensatory capacity. The absence of interstitial infiltrates increased the risk of renal relapse which is a warning sign that patients with a relatively benign onset of disease may also be prone to renal relapse. Renal relapses occurring in patients with sclerotic class AAGN and renal relapses occurring in patients without interstitial infiltrates were mutually exclusive, which may indicate that they are essentially different.

Details

Authors
  • Arda Göçeroǧlu
  • Annelies E. Berden
  • Marta Fiocco
  • Oliver Flobmann
  • Kerstin W. Westman
  • Franco Ferrario
  • Gill Gaskin
  • Charles D. Pusey
  • E. Christiaan Hagen
  • Laure Hélène Noë
  • Niels Rasmussen
  • Rüdiger Waldherr
  • Michael Walsh
  • Jan A. Bruijn
  • David R W Jayne
  • Ingeborg M. Bajema
Organisations
External organisations
  • Leiden University Medical Centre
  • Leiden University
  • Royal Berkshire Hospital
  • University of Milano-Bicocca
  • Hammersmith Hospital
  • Meander Medical Center
  • Paris Descartes University
  • Danish Serum Institute, Copenhagen
  • Heidelberg University
  • McMaster University
  • Addenbrooke's Hospital
  • Skåne University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Other Clinical Medicine
Original languageEnglish
Article numbere0165402
JournalPLoS ONE
Volume11
Issue number12
Publication statusPublished - 2016 Dec 1
Publication categoryResearch
Peer-reviewedYes