Clinical Characteristics and Renal Outcome in Elderly Patients with Antineutrophil Cytoplasmic Autoantibody Associated Vasculitis with Renal Involvement_West China Medical Journal

Authors：

 QIUHong-yu ¹ , FENGPing ² ,  LIUFang ¹ , LILi ¹ , DIAOMing-shu ¹ , ZUOChuan ¹ , ZHONGHui ¹ , LIANGYa-ping ¹ , FUPing ¹

1. Department of Nephrology;West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Institute of Clinical Trials/GCP Center;West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIUFang, Email: liufangfh@163.com

Keywords：

Antineutrophil cytoplasmic autoantibody associated vasculitis; Vasculitic glomerulonephritis; Microscopic polyangiitis; Wegener granulomatosis; End stage renal disease

DOI：

10.7507/1002-0179.20140376

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To analyze the clinical characteristics and renal outcome of elderly patients with antineutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) with renal involvement. Methods We retrospectively analyzed the clinical data of 147 patients with ANCA relate vasculitis treated between June 2006 and June 2012. Based on the age, the patients were divided into elderly group (65 years or older, n=50) and non-elderly group (younger than 65, n=97). The disease course, clinical characteristics, ANCA serological indexes, renal pathological change and prognosis of patients in the two groups were compared and studied. Results In the elderly group, there were 3 cases of Wegener granulomatosis (WG), 45 of microscopic polyangiitis (MPA), and 2 of pauci-immune crescentic glomerulonephritis (PICGN). The non-elderly group had 8 cases of WG, 82 of MPA, 6 of PICGN, and 1 of allergic angitis granulomatosis. There were 5 cases of positive cANCA and 44 of positive pANCA in the elderly group. The elderly patients had significantly more pulmonary involvement than the younger patients (P=0.030). No significant difference was detected between the two groups in combined pulmonary infection (P=0.281) or combined infectious index C-reactive protein (P=0.326). Elderly patients were less likely to respond to sufficient treatment with pulse intravenous methylprednisolone therapy (P=0.035) and cyclophosphamide (P=0.043), and had worse renal outcome than younger patients (P=0.040). Conclusion Elderly patients with AAV have more prevalent pulmonary involvement and have severe complication of pulmonary infection, which affects mortality and morbidity of ANCA-associated systemic vasculitis.

Citation： QIUHong-yu, FENGPing, LIUFang, LILi, DIAOMing-shu, ZUOChuan, ZHONGHui, LIANGYa-ping, FUPing. Clinical Characteristics and Renal Outcome in Elderly Patients with Antineutrophil Cytoplasmic Autoantibody Associated Vasculitis with Renal Involvement. West China Medical Journal, 2014, 29(7): 1224-1228. doi: 10.7507/1002-0179.20140376 Copy

1.	Campo A, Grill A, Stratta P. ANCA-associated renal vasculitis[J]. Kidney Int, 2002, 61(4):1550-1551.
2.	Booth AD, Almond MK, Burns A, et al. Outcome of ANCAassociated renal vasculitis:a 5-year retrospective study[J]. Am J Kidney Dis, 2003, 41(4):776-784.
3.	Hauer HA, Bajema IM, van Houwelingen HC, et al. Renal histology in ANCA-associated vasculitis:differences between diagnostic and serologic subgroups[J]. Kidney Int, 2002, 61(1):80-89.
4.	Yu F, Chen M, Wang SX, et al. Clinical and pathological characteristics and outcomes of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated systemic vasculitis with immune complex deposition in kidney[J]. Nephrology (Carlton), 2007, 12(1):74-80.
5.	Arulkumaran N, Periselneris N, Gaskin G, et al. Interstitial lung disease and ANCA-associated vasculitis:a retrospective observational cohort study[J]. Rheumatology (Oxford), 2011, 50(11):2035-2043.
6.	Suppiah R, Hadden RD, Batra R, et al. Peripheral neuropathy in ANCA-associated vasculitis:outcomes from the European Vasculitis Study Group trials[J]. Rheumatology (Oxford), 2011, 50(12):2214-2222.
7.	Ahn JK, Hwang JW, Lee J, et al. Clinical features and outcome of microscopic polyangiitis under a new consensus algorithm of ANCA-associated vasculitides in Korea[J]. Rheumatol Int, 2012, 32(10):2979-2986.
8.	Chen M, Yu F, Zhang Y, et al. Antineutrophil cytoplasmic autoantibody-associated vasculitis in older patients[J]. Medicine (Baltimore), 2008, 87(4):203-209.
9.	Kostianovsky A, Hauser T, Pagnoux C, et al. Alveolar haemorrhage in ANCA-associated vasculitides:80 patients' features and prognostic factors[J]. Clin Exp Rheumatol, 2012, 30(1 Suppl 70):S77-S82.
10.	Gupta R, Singh L, Sharma A, et al. Crescentic glomerulonephritis:a clinical and histomorphological analysis of 46 cases[J]. Indian J Pathol Microbiol, 2011, 54(3):497-500.
11.	Harper L, Morgan MD, Walsh M, et al. Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis:long-term follow-up[J]. Ann Rheum Dis, 2012, 71(6):955-960.
12.	Koike K, Fukami K, Yonemoto K, et al. A new vasculitis activity score for predicting death in myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis patients[J]. Am J Nephrol, 2012, 35(1):1-6.
13.	Yamagata K, Usui J, Saito C, et al. ANCA-associated systemic vasculitis in Japan:clinical features and prognostic changes[J]. Clin Exp Nephrol, 2012, 16(4):580-588.
14.	Seck SM, Dussol B, Brunet P, et al. Clinical features and outcomes of ANCA-associated renal vasculitis[J]. Saudi J Kidney Dis Transpl, 2012, 23(2):301-305.
15.	Smith RM, Jones RB, Jayne DR. Progress in treatment of ANCAassociated vasculitis[J]. Arthritis Res Ther, 2012, 14(2):210.
16.	Faurschou M, Westman K, Rasmussen N, et al. Long-term outcome of a clinical trial comparing methotrexate to cyclophosphamide for remission induction of early systemic ANCA-associated vasculitis[J]. Arthritis Rheum, 2012, 64(10):3472-3477.

1. Campo A, Grill A, Stratta P. ANCA-associated renal vasculitis[J]. Kidney Int, 2002, 61(4):1550-1551.
2. Booth AD, Almond MK, Burns A, et al. Outcome of ANCAassociated renal vasculitis:a 5-year retrospective study[J]. Am J Kidney Dis, 2003, 41(4):776-784.
3. Hauer HA, Bajema IM, van Houwelingen HC, et al. Renal histology in ANCA-associated vasculitis:differences between diagnostic and serologic subgroups[J]. Kidney Int, 2002, 61(1):80-89.
4. Yu F, Chen M, Wang SX, et al. Clinical and pathological characteristics and outcomes of Chinese patients with primary antineutrophil cytoplasmic antibodies-associated systemic vasculitis with immune complex deposition in kidney[J]. Nephrology (Carlton), 2007, 12(1):74-80.
5. Arulkumaran N, Periselneris N, Gaskin G, et al. Interstitial lung disease and ANCA-associated vasculitis:a retrospective observational cohort study[J]. Rheumatology (Oxford), 2011, 50(11):2035-2043.
6. Suppiah R, Hadden RD, Batra R, et al. Peripheral neuropathy in ANCA-associated vasculitis:outcomes from the European Vasculitis Study Group trials[J]. Rheumatology (Oxford), 2011, 50(12):2214-2222.
7. Ahn JK, Hwang JW, Lee J, et al. Clinical features and outcome of microscopic polyangiitis under a new consensus algorithm of ANCA-associated vasculitides in Korea[J]. Rheumatol Int, 2012, 32(10):2979-2986.
8. Chen M, Yu F, Zhang Y, et al. Antineutrophil cytoplasmic autoantibody-associated vasculitis in older patients[J]. Medicine (Baltimore), 2008, 87(4):203-209.
9. Kostianovsky A, Hauser T, Pagnoux C, et al. Alveolar haemorrhage in ANCA-associated vasculitides:80 patients' features and prognostic factors[J]. Clin Exp Rheumatol, 2012, 30(1 Suppl 70):S77-S82.
10. Gupta R, Singh L, Sharma A, et al. Crescentic glomerulonephritis:a clinical and histomorphological analysis of 46 cases[J]. Indian J Pathol Microbiol, 2011, 54(3):497-500.
11. Harper L, Morgan MD, Walsh M, et al. Pulse versus daily oral cyclophosphamide for induction of remission in ANCA-associated vasculitis:long-term follow-up[J]. Ann Rheum Dis, 2012, 71(6):955-960.
12. Koike K, Fukami K, Yonemoto K, et al. A new vasculitis activity score for predicting death in myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis patients[J]. Am J Nephrol, 2012, 35(1):1-6.
13. Yamagata K, Usui J, Saito C, et al. ANCA-associated systemic vasculitis in Japan:clinical features and prognostic changes[J]. Clin Exp Nephrol, 2012, 16(4):580-588.
14. Seck SM, Dussol B, Brunet P, et al. Clinical features and outcomes of ANCA-associated renal vasculitis[J]. Saudi J Kidney Dis Transpl, 2012, 23(2):301-305.
15. Smith RM, Jones RB, Jayne DR. Progress in treatment of ANCAassociated vasculitis[J]. Arthritis Res Ther, 2012, 14(2):210.
16. Faurschou M, Westman K, Rasmussen N, et al. Long-term outcome of a clinical trial comparing methotrexate to cyclophosphamide for remission induction of early systemic ANCA-associated vasculitis[J]. Arthritis Rheum, 2012, 64(10):3472-3477.

West China Medical Journal

Clinical Characteristics and Renal Outcome in Elderly Patients with Antineutrophil Cytoplasmic Autoantibody Associated Vasculitis with Renal Involvement

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content