Clinic of Nephrology, Internal and Occupational Diseases, Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK.
Nephrol Dial Transplant. 2017 Feb 1;32(2):248-253. doi: 10.1093/ndt/gfw046.
The outcomes in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis have improved significantly over the past decades, although a significant proportion of them still reach end-stage renal disease (ESRD). Renal replacement therapy (RRT) is associated with a relatively low risk of relapsing vasculitis as a result of anti-rejection treatment after kidney transplantation or quiescence of the autoimmune process in haemodialysis patients, but a flare of vasculitis in the latter setting presents a challenge because the treatment is poorly tolerated. There are benefits of rituximab in haemodialysed patients, as it is more steroid sparing in the treatment of extrarenal disease. More favourable outcomes of kidney transplantation compared with haemodialysis support its use as a preferable method of RRT in patients with vasculitis remission or low disease activity.
过去几十年来，抗中性粒细胞胞质抗体（ANCA）相关性血管炎患者的治疗结果显著改善，尽管仍有相当一部分患者进展至终末期肾病（ESRD）。肾替代治疗（RRT）与肾移植后抗排斥治疗或血液透析患者自身免疫过程的静止相关，导致血管炎复发的风险相对较低，但在后者情况下血管炎的发作是一个挑战，因为治疗的耐受性较差。利妥昔单抗对血液透析患者有获益，因为它在治疗肾外疾病时更能减少类固醇的使用。与血液透析相比，肾移植的结果更为有利，支持将其作为血管炎缓解或低疾病活动患者 RRT 的更优方法。
