Enos Daniel, Hernández Mariel, Méndez Gonzalo P, Cáceres Lysis, Bravo Ignacia, Jobet Josefina, Castro Simón, Cornejo Lorena, Vega Catalina, Salazar Andrés
Nephrology Department, Hospital Victor Rios Ruiz (CAVRR), Los Angeles, Biobio, Chile.
Internal Medicine Department, Universidad San Sebastián, Los Angeles, Biobio, Chile.
Front Nephrol. 2025 Jun 16;5:1599316. doi: 10.3389/fneph.2025.1599316. eCollection 2025.
Renal vasculitis is a rare disease, the incidence of which increased markedly during the COVID-19 pandemic in our center. The aim of this study is to compare the incidence and the clinical and histopathological characteristics of anti-neutrophil cytoplasm antibodies (ANCA)-associated vasculitis patients before and during the COVID-19 pandemic.
A single-center observational retrospective analysis of 61 patients with ANCA-associated vasculitis who were divided into two groups according to date of diagnosis: pre-pandemic from 2008 to 2020 (n=37) and during the pandemic from 2020 to the middle of 2022 (n=24). The annual incidence rate was compared, as were characteristics such as age, gender, Birmingham Vasculitis Activity Score (BVAS) score, renal clinic, organ involvement, and ANCA serotype. Biopsy findings, such as optical microscopy glomerular characteristics, crescents, interstitium, immunofluorescence, and electron microscopy findings, were analyzed. Mortality and renal replacement therapy needs were also compared.
The annual incidence rate was higher in the pandemic group compared to the pre-pandemic group, with 9.6 cases per year vs. 3.1 cases per year [incidence rate ratio (IRR)=3.11, 95% CI 1.86 to 5.20]. No significant differences between the groups were found for clinical characteristics, except for greater hemoptysis frequency in the pandemic group. Significant differences in immunofluorescence and electronic microscopy were observed, with a higher IgG deposit and C3 in the pandemic group (37.5% vs 8.1%, p=0.0064; 43.5% vs 10.8%, p=0.009, respectively), whereas the incidence of pauci-immune patterns was higher in the pre-pandemic group (81.1% vs 54.1%, p=0.016). Mortality and the need for renal replacement therapy were significant higher in the pandemic group (IRR=3.56, CI 95% 1.27-9.98 and IRR=4.24, CI 95% 2.08-8.65, respectively).
The incidence of ANCA vasculitis increased during the COVID-19 pandemic and was associated with higher rates of IgG deposit and C3 in the immunofluorescence findings and with higher rates of deaths and dialysis in the pandemic group compared with the pre-pandemic group.
肾血管炎是一种罕见疾病，在我们中心，其发病率在新冠疫情期间显著上升。本研究旨在比较新冠疫情之前和期间抗中性粒细胞胞浆抗体（ANCA）相关血管炎患者的发病率、临床及组织病理学特征。
对61例ANCA相关血管炎患者进行单中心观察性回顾分析，根据诊断日期将患者分为两组：2008年至2020年疫情前组（n = 37）和2020年至2022年年中疫情期间组（n = 24）。比较年发病率，以及年龄、性别、伯明翰血管炎活动评分（BVAS）、肾脏临床表现、器官受累情况和ANCA血清型等特征。分析活检结果，如光学显微镜下的肾小球特征、新月体、间质、免疫荧光和电子显微镜检查结果。还比较了死亡率和肾脏替代治疗需求。
疫情期间组的年发病率高于疫情前组，分别为每年9.6例和每年3.1例[发病率比（IRR）= 3.11，95%置信区间1.86至5.20]。除疫情期间组咯血频率更高外，两组临床特征无显著差异。免疫荧光和电子显微镜检查存在显著差异，疫情期间组IgG沉积和C3更高（分别为37.5%对8.1%，p = 0.0064；43.5%对10.8%，p = 0.009），而寡免疫模式的发生率在疫情前组更高（81.1%对54.1%，p = 0.016）。疫情期间组的死亡率和肾脏替代治疗需求显著更高（IRR分别为3.56，95%置信区间1.27 - 9.98；IRR为4.24，95%置信区间2.08 - 8.65）。
新冠疫情期间ANCA血管炎的发病率增加，与免疫荧光检查中更高的IgG沉积和C3率相关，且与疫情前组相比，疫情期间组的死亡率和透析率更高。
