Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Institute of Nephrology, Zhejiang University, Hangzhou, China.
Front Immunol. 2021 Jul 9;12:641655. doi: 10.3389/fimmu.2021.641655. eCollection 2021.
Kidney involvement is common in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It tends to be aggressive, and in some patients, the kidney involvement may reach the criteria of acute kidney injury (AKI). Here, we aim to describe the clinical characteristics of these patients and find risk factors for poor outcomes.
Patients diagnosed with AAV in our hospital from February 2003 to February 2017 were included. Those who reached the KDIGO AKI criteria were reclassified according to the KDIGO AKI stage. The clinical features of these patients were analyzed. Also, according to the variation of serum creatinine 3 months after AKI episode, patients were further divided into two groups: patients whose serum creatinine (Scr) level at the third month decreased by 30% or more from the peak Scr level was classified into G1 and others were classified into G2. Long-term renal and survival outcomes of these patients were analyzed with a Cox model. The renal endpoint was reaching end-stage renal disease (ESRD), and the survival endpoint was death. Nomograms were built based on cox models.
Of 141 AAV patients included, during the median follow-up period of 64.0 (IQR 34.8, 85.4) months, 36 (25.5%) patients reached renal endpoints, and 22 (15.6%) patients died. The median renal survival time was 35.9 (IQR 21.3, 72.6) months and the median survival time was 48.4 (IQR 26.8, 82.8) months. Multivariate analysis showed that poor recovery of Scr level at 90 days (P < 0.001, RR = 9.150, 95%CI 4.163-20.113), BVAS score (P = 0.014, RR = 1.110, 95% CI1.021-1.207), and AKI stage 3 (P = 0.012 RR = 3.116, 95%CI 1.278-7.598) were independent risk factors for renal endpoints; poor recovery of Scr level at 90 days (P = 0.010, RR = 3.264, 95%CI 1.326-8.035), BVAS score (P = 0.010, RR = 1.171, 95%CI 1.038-1.320) and age (P = 0.017, RR = 1.046, 95%CI 1.008-1.086) were independent risk factors for all-cause death. The c-index of nomograms is 0.830 for the renal outcome and 0.763 for the survival outcome.
KDIGO AKI stage 3 is the risk factor for ESRD in AAV patients with AKI. The BVAS score and level of kidney function recovery at 90 days are the independent risk factors for both ESRD and all-cause death and are of predictive value for the outcome.
抗中性粒细胞胞浆抗体（ANCA）相关性血管炎（AAV）常累及肾脏。肾脏病变常较为严重，部分患者的肾脏受累可达到急性肾损伤（AKI）的标准。本研究旨在描述此类患者的临床特征，并寻找不良预后的危险因素。
纳入 2003 年 2 月至 2017 年 2 月期间在我院确诊为 AAV 的患者。根据 KDIGO AKI 标准，将达到 AKI 标准的患者重新分类。分析这些患者的临床特征。根据 AKI 后 3 个月血清肌酐（Scr）的变化，患者进一步分为两组：Scr 水平在第 3 个月比峰值 Scr 水平下降 30%或更多的患者归入 G1 组，其余患者归入 G2 组。采用 Cox 模型分析这些患者的长期肾脏和生存结局。肾脏终点为达到终末期肾病（ESRD），生存终点为死亡。根据 Cox 模型构建列线图。
在中位随访 64.0（IQR 34.8，85.4）个月期间，141 例 AAV 患者中，36 例（25.5%）患者达到肾脏终点，22 例（15.6%）患者死亡。中位肾脏无事件生存时间为 35.9（IQR 21.3，72.6）个月，中位总生存时间为 48.4（IQR 26.8，82.8）个月。多因素分析显示，90 天时 Scr 水平恢复不良（P<0.001，RR=9.150，95%CI 4.163-20.113）、BVAS 评分（P=0.014，RR=1.110，95%CI 1.021-1.207）和 AKI 3 期（P=0.012，RR=3.116，95%CI 1.278-7.598）是肾脏结局的独立危险因素；90 天时 Scr 水平恢复不良（P=0.010，RR=3.264，95%CI 1.326-8.035）、BVAS 评分（P=0.010，RR=1.171，95%CI 1.038-1.320）和年龄（P=0.017，RR=1.046，95%CI 1.008-1.086）是全因死亡的独立危险因素。列线图的 C 指数在肾脏结局方面为 0.830，在生存结局方面为 0.763。
KDIGO AKI 3 期是 AAV 合并 AKI 患者发生 ESRD 的危险因素。BVAS 评分和 90 天时肾功能恢复情况是 ESRD 和全因死亡的独立危险因素，对结局具有预测价值。
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