Outcomes in Mexican Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Kidney Involvement.

Abstract

Background/objective: This study assessed the outcomes of patients with antineutrophil cytoplasm antibody-associated vasculitis glomerulonephritis (AAV-GN).

Methods: This historical cohort study included patients with AAV-GN evaluated from 2000 to 2022. The outcomes included recovery of kidney function from kidney replacement therapy, incidence of kidney relapses, and early or late progression to kidney failure. All outcomes were assessed by time-to-event analyses, and predictors were evaluated through Cox proportional hazards regression.

Results: Among 154 patients, 104 (68%) were female with a median age of 52 years (interquartile range [IQR], 38-61 years). The median creatinine and estimated glomerular filtration rate at presentation were 2.5 mg/dL (IQR, 1.8-4.5 mg/dL) and 23 mL/min per 1.73 m2 (IQR, 12-36 mL/min per 1.73 m2), respectively. Fifty patients (32%) initially required kidney replacement therapy, with 22 (44%) of them subsequently recovering kidney function. Higher serum creatinine and a lower percentage of normal glomeruli were associated with lower rates of kidney function recovery. The kidney relapse rate was 24.9% by 5 years and 31.4% by 7 years. Proteinase 3-antineutrophil cytoplasm antibody positivity, kidney function, and persistent hematuria were associated with relapses. Kidney failure rates were 19.6% by 1 year and 30.5% by 5 years. Higher serum creatinine and proteinuria and a lower percentage of normal glomeruli were associated with higher rates of early kidney failure. Kidney relapses, persistent proteinuria, and kidney function posttreatment were associated with higher rates of late kidney failure.

Conclusions: The parameters at presentation of an episode of AAV-GN (creatinine, proteinuria, percentage of normal glomeruli) associate with progression to kidney failure within the first year. However, progression to kidney failure after the first year depends on posttreatment parameters and kidney relapses.