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Renal vasculitis presenting with acute kidney injury

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Abstract

Renal failure secondary to ANCA-associated vasculitis represents a clinical and therapeutic challenge. In this study, we aimed to assess the treatment response rates and long-term outcomes of vasculitis patients presenting with renal failure. This retrospective study included 151 patients with renal vasculitis from three hospitals who underwent a renal biopsy between 1997 and 2014. Patients with renal failure which required dialysis at the onset were compared to those presenting with more preserved renal function. The primary end point was treatment response and patient surivival. Patients with severe renal involvement had a lower response to treatment compared to those having preserved renal function (26.6 versus 93.4%; p < 0.001). Dialysis-dependent patients who received plasmapheresis in addition to immune suppressants associated a higher rate of renal recovery (41.6 versus 12.5%; p = 0.05). A higher incidence of severe infections was observed among patients with severe renal involvement (38.4 versus 18.1%, p = 0.01). The mortality rate was significantly higher among vasculitis patients presenting with renal failure (53.8 versus 22.2%, p = 0.001). Global survival at 1 and 5 years was 60 and 47% in patients requiring dialysis compared with 90 and 80% among those with more preserved renal function (p < 0.001). After multivariate adjustment, the need for dialysis remained as an independent predictor of death (HR 2.5; 95% CI 1.1–5.7; p = 0.03). The presence of severe renal dysfunction represents an independent risk factor for patient survival in renal vasculitis. Patients requiring dialysis associate a lower response rate to immunosuppressive therapy and a higher incidence of severe infections.

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Acknowledgements

We would like to thank all the clinicians and pathologists from for their cooperation.

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Authors and Affiliations

  1. Nephrology Department, Hospital Universitario Fundacion, C/Budapest 1, Alcorcon, 28922, Comunidad De Madrid, Spain

    Javier Villacorta & Gema Fernandez-Juarez

  2. Pathology Department, Hospital Virgen de la Salud, Toledo, Spain

    Francisco Diaz-Crespo

  3. Nephrology Department, Hospital Virgen de la Salud, Toledo, Spain

    Mercedes Acevedo

  4. Pathology Department, Hospital Universitario Fundacion Alcorcon, Madrid, Spain

    Carmen Guerrero

  5. Nephrology Department, Hospital Universitario Doce de Octubre, Madrid, Spain

    Teresa Cavero & Manuel Praga

Authors
  1. Javier Villacorta
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  2. Francisco Diaz-Crespo
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  3. Mercedes Acevedo
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  4. Teresa Cavero
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  5. Carmen Guerrero
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  6. Manuel Praga
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  7. Gema Fernandez-Juarez
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Correspondence to Javier Villacorta.

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No funding was received for the study.

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The authors declare that they have no conflict of interest.

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Villacorta, J., Diaz-Crespo, F., Acevedo, M. et al. Renal vasculitis presenting with acute kidney injury. Rheumatol Int 37, 1035–1041 (2017). https://doi.org/10.1007/s00296-017-3697-2

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  • DOI: https://doi.org/10.1007/s00296-017-3697-2

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