Clinical features and prognostic analysis of antineutrophil cytoplasmic antibody-associated vasculitis complicated with acute kidney injury_West China Medical Journal

Authors：

DONG Rui ^1,2 , QIN Jianhua ^1,2 , ZHANG Fan ^1,2 , WANG Yujie ^1,2 , ZHANG Yannan ^1,2 ,  WU Weihua ^1,2

1. Department of Nephrology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Sichuan Clinical Research Center for Nephropathy, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

WU Weihua, Email: 12390369@qq.com

Keywords：

Acute kidney injury; anti-neutrophil cytoplasmic antibody-associated vasculitis; clinical characteristics; prognostic analysis

DOI：

10.7507/1002-0179.202206035

Video：

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Objective To investigate the clinical characteristics and prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with acute kidney injury (AKI) as the first manifestation, and provide new ideas for the prevention and treatment of this disease. Methods A retrospective analysis was performed on 144 patients diagnosed with ANCA-associated vasculitis in Affiliated Hospital of Southwest Medical University between August 2013 and March 2020. The patients were divided into AKI group and non-AKI group according to whether they were complicated with AKI at admission, and the differences in clinical characteristics were analyzed. The risk factors were screened by multiple logistic regression analysis. Results Among the 144 patients with ANCA-associated vasculitis, 30 cases (20.8%) were complicated with AKI at admission, and 70 cases (48.6%) died by the end of follow-up. There were 16 death cases (53.3%) in the AKI group, and 54 death cases (47.4%) in the non-AKI group, but the difference was not statistically significant (P>0.05). Single-factor analyses showed that in the AKI group, the pre-admission incidence of hematuria, neutrophil count, serum creatinine, systolic blood pressure, and Birmingham Vasculitis Activity Score were higher than those in the non-AKI group, while the red blood cell count and estimated glomerular filtration rate (eGFR) were lower than those in the non-AKI group, and the differences were statistically significant (P<0.05). Multiple logistic regression analysis showed that the neutrophil count [odds ratio (OR)=1.172, 95% confidence interval (CI) (1.003, 1.371), P=0.046] and eGFR [OR=0.942, 95%CI (0.907, 0.979), P=0.002] were independent influencing factors for AKI. Conclusions Elevated neutrophil count is an independent risk factor for ANCA-associated vasculitis complicated with AKI. It has certain guiding significance for clinical work. Early identification and intervention of these patients may contribute to reduce the case fatality rate and improve prognosis.

Citation： DONG Rui, QIN Jianhua, ZHANG Fan, WANG Yujie, ZHANG Yannan, WU Weihua. Clinical features and prognostic analysis of antineutrophil cytoplasmic antibody-associated vasculitis complicated with acute kidney injury. West China Medical Journal, 2022, 37(7): 1016-1021. doi: 10.7507/1002-0179.202206035 Copy

1.	谢丽娇. ANCA 相关性血管炎的预后及其相关影响因素的筛查及分析. 重庆: 第三军医大学, 2017.
2.	杨枢苗. 101 例 ANCA 相关性血管炎肾损害患者回顾性临床和病理分析. 长春: 吉林大学, 2020.
3.	Jennette JC. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin Exp Nephrol, 2013, 17(5): 603-606.
4.	余国宝. KDIGO 急性肾损伤临床实践指南//江西省中西医结合学会重症医学专业委员会成立大会暨第一届长城危重病论坛论文汇编. 南昌: 江西省中西医结合学会, 2013: 84-90.
5.	Flossmann O, Bacon P, de Groot K, et al. Development of comprehensive disease assessment in systemic vasculitis. Ann Rheum Dis, 2007, 66(3): 283-292.
6.	Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med, 2012, 367(1): 20-29.
7.	Jennette JC, Falk RJ, Andrassy K, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum, 1994, 37(2): 187-192.
8.	李倩倩, 李胜开. 合并肾损害的抗中性粒细胞胞浆抗体相关性血管炎患者临床资料分析. 中国医药导报, 2018, 15(12): 48-52.
9.	郑明珠. 伴肾脏受累的 MPO 阳性 ANCA 相关性血管炎的预后相关因素分析. 长春: 吉林大学, 2020.
10.	周洁清, 姜红. 血尿的病因及发生机制. 中国实用儿科杂志, 2014, 29(4): 245-248.
11.	马兰. 伴与不伴肾功能不全的 IgA 肾病患者预后危险因素分析. 银川: 宁夏医科大学, 2019.
12.	池晓华, 李贵平, 刘峰, 等. GFR、血肌酐及 24h 尿蛋白定量在评价糖尿病患者肾功能中的应用. 核技术, 2013, 36(6): 31-34.
13.	尚朋. 胱抑素 C 和血肌酐检测在慢性肾脏病诊断和肾功能损伤程度评估中的临床价值. 中外女性健康研究, 2020(12): 175-176.
14.	张艳, 李博, 侯立, 等. 抗中性粒细胞胞浆抗体相关性血管炎合并肾脏损害的临床分析. 宁夏医学杂志, 2017, 39(3): 200-203.
15.	薛超, 卜昆鹏, 罗佐杰, 等. 原发 ANCA 相关性小血管炎发生慢性肾功能衰竭的临床分析. 广东医学, 2011, 32(4): 451-454.
16.	Hakroush S, Tampe D, Ströbel P, et al. Comparative histological subtyping of immune cell infiltrates in MPO-ANCA and PR3-ANCA glomerulonephritis. Front Immunol, 2021, 12: 737708.
17.	陈旻. 原发性小血管炎发病机制研究进展. 中华肾病研究电子杂志, 2014, 3(6): 297-303.
18.	邢广群, 李敏, 魏志敏. 中性粒细胞细胞外网络在 ANCA 相关性小血管炎患者肾组织中的表达及意义. 中国中西医结合肾病杂志, 2012, 13(11): 960-962, 后插 3.
19.	刘国平, 王春艳, 徐丽斌, 等. ANCA 相关性血管炎肾脏及其他系统损害的临床和病理与预后的相关研究. 临床肾脏病杂志, 2016, 16(8): 457-461.
20.	汤海莲, 李建军, 毕杰, 等. 不同年龄段成人 ANCA 相关性血管炎肾损害患者临床病理差异性分析. 河北医学, 2020, 26(7): 1152-1157.
21.	施嘉, 杜晓刚. 抗中性粒细胞胞质抗体相关性血管炎患者的临床特征及预后分析. 第二军医大学学报, 2020, 41(1): 49-56.
22.	Sznajd J, Mukhtyar C. How to treat ANCA-associated vasculitis: practical messages from 2016 EULAR/ERA-EDTA recommendations. Pol Arch Med Wewn, 2016, 126(10): 781-788.
23.	何倩. 抗中性粒细胞胞浆髓过氧化物酶抗体相关性血管炎（MPO-AAV）患者外周血中性粒细胞外捕网水平的变化及意义. 合肥: 安徽医科大学, 2018.

1. 谢丽娇. ANCA 相关性血管炎的预后及其相关影响因素的筛查及分析. 重庆: 第三军医大学, 2017.
2. 杨枢苗. 101 例 ANCA 相关性血管炎肾损害患者回顾性临床和病理分析. 长春: 吉林大学, 2020.
3. Jennette JC. Overview of the 2012 revised International Chapel Hill Consensus Conference nomenclature of vasculitides. Clin Exp Nephrol, 2013, 17(5): 603-606.
4. 余国宝. KDIGO 急性肾损伤临床实践指南//江西省中西医结合学会重症医学专业委员会成立大会暨第一届长城危重病论坛论文汇编. 南昌: 江西省中西医结合学会, 2013: 84-90.
5. Flossmann O, Bacon P, de Groot K, et al. Development of comprehensive disease assessment in systemic vasculitis. Ann Rheum Dis, 2007, 66(3): 283-292.
6. Inker LA, Schmid CH, Tighiouart H, et al. Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med, 2012, 367(1): 20-29.
7. Jennette JC, Falk RJ, Andrassy K, et al. Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum, 1994, 37(2): 187-192.
8. 李倩倩, 李胜开. 合并肾损害的抗中性粒细胞胞浆抗体相关性血管炎患者临床资料分析. 中国医药导报, 2018, 15(12): 48-52.
9. 郑明珠. 伴肾脏受累的 MPO 阳性 ANCA 相关性血管炎的预后相关因素分析. 长春: 吉林大学, 2020.
10. 周洁清, 姜红. 血尿的病因及发生机制. 中国实用儿科杂志, 2014, 29(4): 245-248.
11. 马兰. 伴与不伴肾功能不全的 IgA 肾病患者预后危险因素分析. 银川: 宁夏医科大学, 2019.
12. 池晓华, 李贵平, 刘峰, 等. GFR、血肌酐及 24h 尿蛋白定量在评价糖尿病患者肾功能中的应用. 核技术, 2013, 36(6): 31-34.
13. 尚朋. 胱抑素 C 和血肌酐检测在慢性肾脏病诊断和肾功能损伤程度评估中的临床价值. 中外女性健康研究, 2020(12): 175-176.
14. 张艳, 李博, 侯立, 等. 抗中性粒细胞胞浆抗体相关性血管炎合并肾脏损害的临床分析. 宁夏医学杂志, 2017, 39(3): 200-203.
15. 薛超, 卜昆鹏, 罗佐杰, 等. 原发 ANCA 相关性小血管炎发生慢性肾功能衰竭的临床分析. 广东医学, 2011, 32(4): 451-454.
16. Hakroush S, Tampe D, Ströbel P, et al. Comparative histological subtyping of immune cell infiltrates in MPO-ANCA and PR3-ANCA glomerulonephritis. Front Immunol, 2021, 12: 737708.
17. 陈旻. 原发性小血管炎发病机制研究进展. 中华肾病研究电子杂志, 2014, 3(6): 297-303.
18. 邢广群, 李敏, 魏志敏. 中性粒细胞细胞外网络在 ANCA 相关性小血管炎患者肾组织中的表达及意义. 中国中西医结合肾病杂志, 2012, 13(11): 960-962, 后插 3.
19. 刘国平, 王春艳, 徐丽斌, 等. ANCA 相关性血管炎肾脏及其他系统损害的临床和病理与预后的相关研究. 临床肾脏病杂志, 2016, 16(8): 457-461.
20. 汤海莲, 李建军, 毕杰, 等. 不同年龄段成人 ANCA 相关性血管炎肾损害患者临床病理差异性分析. 河北医学, 2020, 26(7): 1152-1157.
21. 施嘉, 杜晓刚. 抗中性粒细胞胞质抗体相关性血管炎患者的临床特征及预后分析. 第二军医大学学报, 2020, 41(1): 49-56.
22. Sznajd J, Mukhtyar C. How to treat ANCA-associated vasculitis: practical messages from 2016 EULAR/ERA-EDTA recommendations. Pol Arch Med Wewn, 2016, 126(10): 781-788.
23. 何倩. 抗中性粒细胞胞浆髓过氧化物酶抗体相关性血管炎（MPO-AAV）患者外周血中性粒细胞外捕网水平的变化及意义. 合肥: 安徽医科大学, 2018.

West China Medical Journal

Clinical features and prognostic analysis of antineutrophil cytoplasmic antibody-associated vasculitis complicated with acute kidney injury

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