Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
Department of Nephrology, Nagoya University Hospital, Nagoya, Aichi, Japan.
Clin Exp Nephrol. 2024 Jul;28(7):701-706. doi: 10.1007/s10157-024-02522-6. Epub 2024 Jun 8.
Kidney and life outcomes remain unsatisfactory in patients with microscopic polyangiitis (MPA). Appropriate treatment intensity must be provided to the appropriate patients. To identify severe cases early, we investigated the factors related to kidney and life outcomes.
We included patients diagnosed with MPA based on myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) positivity and kidney histopathology results after kidney biopsies between January 1, 2021, and May 11, 2023, at 10 affiliated centers, including our hospital. Death, maintenance dialysis, and estimated glomerular filtration rate (eGFR) < 15 after 6 months of treatment were defined as poor prognosis groups, and factors associated with these conditions were investigated.
We included 84 (36 men and 48 women) patients in this study. Median age was 73.8 (interquartile range: 71-81) years. After 6 months of treatment, the proportion of patients in the poor prognosis group was 16.7 %, with a mortality of 7.1 % and a poor kidney prognosis rate of 9.5 %. Area under the receiver operating characteristic curve showed that eGFR at 2 weeks had a comparable prognostic performance equal as eGFR at 4 weeks (area under the curve: 0.875 and 0.896, respectively). After adjustment by various factors, eGFR at 2 weeks was related with prognosis significantly (p = 0.031).
Kidney function 2 weeks after the start of treatment for MPA can predict prognosis.
显微镜下多血管炎（MPA）患者的肾脏和生存结局仍不理想。必须为合适的患者提供适当的治疗强度。为了早期识别重症病例，我们研究了与肾脏和生存结局相关的因素。
我们纳入了 2021 年 1 月 1 日至 2023 年 5 月 11 日期间在 10 家附属医院（包括我院）基于髓过氧化物酶-抗中性粒细胞胞质抗体（MPO-ANCA）阳性和肾活检后肾脏病理结果诊断为 MPA 的患者。将治疗 6 个月后死亡、维持性透析和估计肾小球滤过率（eGFR）<15ml/min/1.73m²定义为预后不良组，研究与这些情况相关的因素。
本研究共纳入 84 例（36 名男性和 48 名女性）患者。中位年龄为 73.8（四分位距：71-81）岁。治疗 6 个月后，预后不良组的患者比例为 16.7%，死亡率为 7.1%，肾脏预后不良率为 9.5%。受试者工作特征曲线下面积显示，治疗后 2 周的 eGFR 与治疗后 4 周的 eGFR 具有相当的预后预测能力（曲线下面积分别为 0.875 和 0.896）。经多种因素调整后，治疗后 2 周的 eGFR 与预后显著相关（p=0.031）。
MPA 治疗开始后 2 周的肾功能可以预测预后。
