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

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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.	謝麗嬌. ANCA 相關性血管炎的預后及其相關影響因素的篩查及分析. 重慶: 第三軍醫大學, 2017.
2.	楊樞苗. 101 例 ANCA 相關性血管炎腎損害患者回顧性臨床和病理分析. 長春: 吉林大學, 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.	余國寶. KDIGO 急性腎損傷臨床實踐指南//江西省中西醫結合學會重癥醫學專業委員會成立大會暨第一屆長城危重病論壇論文匯編. 南昌: 江西省中西醫結合學會, 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, 李勝開. 合并腎損害的抗中性粒細胞胞漿抗體相關性血管炎患者臨床資料分析. 中國醫藥導報, 2018, 15(12): 48-52.
9.	鄭明珠. 伴腎臟受累的 MPO 陽性 ANCA 相關性血管炎的預后相關因素分析. 長春: 吉林大學, 2020.
10.	周潔清, 姜紅. 血尿的病因及發生機制. 中國實用兒科雜志, 2014, 29(4): 245-248.
11.	馬蘭. 伴與不伴腎功能不全的 IgA 腎病患者預后危險因素分析. 銀川: 寧夏醫科大學, 2019.
12.	池曉華, 李貴平, 劉峰, 等. GFR、血肌酐及 24h 尿蛋白定量在評價糖尿病患者腎功能中的應用. 核技術, 2013, 36(6): 31-34.
13.	尚朋. 胱抑素 C 和血肌酐檢測在慢性腎臟病診斷和腎功能損傷程度評估中的臨床價值. 中外女性健康研究, 2020(12): 175-176.
14.	張艷, 李博, 侯立, 等. 抗中性粒細胞胞漿抗體相關性血管炎合并腎臟損害的臨床分析. 寧夏醫學雜志, 2017, 39(3): 200-203.
15.	薛超, 卜昆鵬, 羅佐杰, 等. 原發 ANCA 相關性小血管炎發生慢性腎功能衰竭的臨床分析. 廣東醫學, 2011, 32(4): 451-454.
16.	Hakroush S, Tampe D, Str?bel P, et al. Comparative histological subtyping of immune cell infiltrates in MPO-ANCA and PR3-ANCA glomerulonephritis. Front Immunol, 2021, 12: 737708.
17.	陳旻. 原發性小血管炎發病機制研究進展. 中華腎病研究電子雜志, 2014, 3(6): 297-303.
18.	邢廣群, 李敏, 魏志敏. 中性粒細胞細胞外網絡在 ANCA 相關性小血管炎患者腎組織中的表達及意義. 中國中西醫結合腎病雜志, 2012, 13(11): 960-962, 后插 3.
19.	劉國平, 王春艷, 徐麗斌, 等. ANCA 相關性血管炎腎臟及其他系統損害的臨床和病理與預后的相關研究. 臨床腎臟病雜志, 2016, 16(8): 457-461.
20.	湯海蓮, 李建軍, 畢杰, 等. 不同年齡段成人 ANCA 相關性血管炎腎損害患者臨床病理差異性分析. 河北醫學, 2020, 26(7): 1152-1157.
21.	施嘉, 杜曉剛. 抗中性粒細胞胞質抗體相關性血管炎患者的臨床特征及預后分析. 第二軍醫大學學報, 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. 抗中性粒細胞胞漿髓過氧化物酶抗體相關性血管炎（MPO-AAV）患者外周血中性粒細胞外捕網水平的變化及意義. 合肥: 安徽醫科大學, 2018.

1. 謝麗嬌. ANCA 相關性血管炎的預后及其相關影響因素的篩查及分析. 重慶: 第三軍醫大學, 2017.
2. 楊樞苗. 101 例 ANCA 相關性血管炎腎損害患者回顧性臨床和病理分析. 長春: 吉林大學, 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. 余國寶. KDIGO 急性腎損傷臨床實踐指南//江西省中西醫結合學會重癥醫學專業委員會成立大會暨第一屆長城危重病論壇論文匯編. 南昌: 江西省中西醫結合學會, 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, 李勝開. 合并腎損害的抗中性粒細胞胞漿抗體相關性血管炎患者臨床資料分析. 中國醫藥導報, 2018, 15(12): 48-52.
9. 鄭明珠. 伴腎臟受累的 MPO 陽性 ANCA 相關性血管炎的預后相關因素分析. 長春: 吉林大學, 2020.
10. 周潔清, 姜紅. 血尿的病因及發生機制. 中國實用兒科雜志, 2014, 29(4): 245-248.
11. 馬蘭. 伴與不伴腎功能不全的 IgA 腎病患者預后危險因素分析. 銀川: 寧夏醫科大學, 2019.
12. 池曉華, 李貴平, 劉峰, 等. GFR、血肌酐及 24h 尿蛋白定量在評價糖尿病患者腎功能中的應用. 核技術, 2013, 36(6): 31-34.
13. 尚朋. 胱抑素 C 和血肌酐檢測在慢性腎臟病診斷和腎功能損傷程度評估中的臨床價值. 中外女性健康研究, 2020(12): 175-176.
14. 張艷, 李博, 侯立, 等. 抗中性粒細胞胞漿抗體相關性血管炎合并腎臟損害的臨床分析. 寧夏醫學雜志, 2017, 39(3): 200-203.
15. 薛超, 卜昆鵬, 羅佐杰, 等. 原發 ANCA 相關性小血管炎發生慢性腎功能衰竭的臨床分析. 廣東醫學, 2011, 32(4): 451-454.
16. Hakroush S, Tampe D, Str?bel P, et al. Comparative histological subtyping of immune cell infiltrates in MPO-ANCA and PR3-ANCA glomerulonephritis. Front Immunol, 2021, 12: 737708.
17. 陳旻. 原發性小血管炎發病機制研究進展. 中華腎病研究電子雜志, 2014, 3(6): 297-303.
18. 邢廣群, 李敏, 魏志敏. 中性粒細胞細胞外網絡在 ANCA 相關性小血管炎患者腎組織中的表達及意義. 中國中西醫結合腎病雜志, 2012, 13(11): 960-962, 后插 3.
19. 劉國平, 王春艷, 徐麗斌, 等. ANCA 相關性血管炎腎臟及其他系統損害的臨床和病理與預后的相關研究. 臨床腎臟病雜志, 2016, 16(8): 457-461.
20. 湯海蓮, 李建軍, 畢杰, 等. 不同年齡段成人 ANCA 相關性血管炎腎損害患者臨床病理差異性分析. 河北醫學, 2020, 26(7): 1152-1157.
21. 施嘉, 杜曉剛. 抗中性粒細胞胞質抗體相關性血管炎患者的臨床特征及預后分析. 第二軍醫大學學報, 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. 抗中性粒細胞胞漿髓過氧化物酶抗體相關性血管炎（MPO-AAV）患者外周血中性粒細胞外捕網水平的變化及意義. 合肥: 安徽醫科大學, 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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