Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression?
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
Resumo: | ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations. |
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Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression?Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosisAnti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapyGlomerulonephritisImmunosuppression TherapyRenal DialysisABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations.Sociedade Portuguesa de Nefrologia2022-12-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223Portuguese Journal of Nephrology & Hypertension v.36 n.4 2022reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223Nogueira,Rui FilipeOliveira,Nuno AfonsoGaudêncio,MargaridaBelmira,AnaAlves,Ruiinfo:eu-repo/semantics/openAccess2024-02-06T17:05:15Zoai:scielo:S0872-01692022000400223Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:19:08.516269Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
title |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
spellingShingle |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? Nogueira,Rui Filipe Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
title_short |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
title_full |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
title_fullStr |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
title_full_unstemmed |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
title_sort |
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
author |
Nogueira,Rui Filipe |
author_facet |
Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
author_role |
author |
author2 |
Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
dc.subject.por.fl_str_mv |
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
topic |
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
description |
ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-12-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.36 n.4 2022 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799137280867172352 |