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Determinants of renal and patient outcomes in a Spanish cohort of patients with ANCA-associated vasculitis and renal involvement

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Abstract

The classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains controversial. The main objective of this study was to define the respective values of ANCA serotype-based classification, clinicopathological classification, and histopathological classification in predicting patient and renal outcomes in a Spanish cohort of patients with ANCA with specificity for myeloperoxidase, MPO-ANCA, versus ANCA with specificity for proteinase 3, PR3-ANCA. Two hundred and forty-five patients with ANCA-AAV and biopsy-proven renal involvement diagnosed between 2000 and 2104 were recruited in 12 nephrology services. Clinical and histologic data, renal outcomes, and mortality were analyzed. We applied the Chapel Hill Consensus Conference definition with categories for granulomatosis with the polyangiitis (GPA) and microscopic polyangiitis (MPA), the classification based on ANCA specificity, and the histopathological classification proposed in 2010. Eighty-two percent were MPO-ANCA positive and 18.0% PR3-ANCA positive. Altogether, 82.9% had MPA and 17.1% GPA. The median follow-up was 43.2 months (0.1–169.3). Neither ANCA-based serological nor clinical classification was predictive of renal outcomes or patient survival on bivariate or multivariate Cox regression analysis. Histopathological classification was found to predict development of end-stage renal disease (p = 0.005) in Kaplan-Meier analysis. ANCA specificity was more predictive of relapse than clinicopathological classification in multivariate analysis (HR 2.086; 95% CI 1.046–4.158; p = 0.037). In our Spanish cohort, a majority of patients had an MPO-ANCA-AAV. A classification based on ANCA specificity has a higher predictive value for relapse occurrence and could be used for decision-making with respect to induction treatment and maintenance therapies.

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Acknowledgements

We thank all the physicians who have been involved in the care of patients included in this study or have helped in the development of the study and this article.

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Author notes

  1. J. Ballarin and M M. Díaz-Encarnación contributed equally to this work.

Authors and Affiliations

  1. Nephrology Division, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain

    H. Marco & M. Navarro-Díaz

  2. Nephrology Division, Hospital Universitari de Bellvitge, Barcelona, Universitat Autonoma de Barcelona, Barcelona, Spain

    J. Draibe

  3. Nephrology Division, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    J. Villacorta

  4. Nephrology Division, Hospital Universitari Clínic de Barcelona, Barcelona, Spain

    L. F. Quintana

  5. Nephrology Division, Hospital Universitari Dr. J. Trueta, Girona, Spain

    N. Martin

  6. Nephrology Division, Hospital de Palamós, Girona, Spain

    R. Garcia-Osuna

  7. Nephrology Division, Hospital Universitari Joan XXIII, Tarragona, Spain

    C. Cabre

  8. Nephrology Division, Hospital de Poniente, Almeria, Spain

    MA. Martín-Gómez

  9. Nephrology Division, Fundación Althaia, Manresa, Spain

    A. Balius

  10. Nephrology Division, Hospital de Terrassa, Terrassa, Spain

    A. Saurina

  11. Nephrology Division, Hospital de Figueres, Girona, Spain

    M. Picazo

  12. Clinical Epidemiology Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    I. Gich-Saladich

  13. Nephrology Division, Hospital Universitario 12 de Octubre, Madrid, Spain

    M. Praga & T. Cavero

  14. Nephrology Division, Hospital Universitari Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain

    J. Ballarin & M M Díaz-Encarnación

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  1. H. Marco
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for the Spanish Group for the Study of Glomerular Disease (GLOSEN)

Contributions

Jose Ballarin and Montserrat Diaz-Encarnación are joint last authors. They have contributed equally to the study.

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Correspondence to M M Díaz-Encarnación.

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Marco, H., Draibe, J., Villacorta, J. et al. Determinants of renal and patient outcomes in a Spanish cohort of patients with ANCA-associated vasculitis and renal involvement. Clin Rheumatol 37, 1065–1074 (2018). https://doi.org/10.1007/s10067-017-3973-2

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