Predicting prognosis in ANCA-associated vasculitis with kidney involvement.

IF 4.6 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-08-26 eCollection Date: 2025-09-01 DOI:10.1093/ckj/sfaf268
Christian Maalouli, Selda Aydin, Alix Collard, Jean-Francois Cambier, Agnes Dejardin, Benoit Georges, Gaelle Gillerot, Benedicte Vanderperren, Ann-Karolien Vandooren, Michel Jadoul, Johann Morelle, Nathalie Demoulin
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引用次数: 0

Abstract

Background: The ANCA Renal Risk Score was updated in 2023 to the ANCA Kidney Risk Score (AKRiS) to improve clinicopathological prognostication in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and kidney involvement. Our study aimed to assess whether incorporating recently identified predictors of kidney survival in AAV could further refine the prognostic accuracy of AKRiS in our multicentric cohort.

Methods: We retrospectively reviewed all incident AAV with kidney biopsy from 2005 to 2020. Cox regression analysis examined factors [AKRiS, dialysis within 4 weeks, urine protein-creatinine ratio (UPCR) and hematuria at baseline, C3 deposits, renal arteritis on biopsy, estimated glomerular filtration rate (eGFR), UPCR and hematuria after induction] associated with kidney failure. These factors in combination with AKRiS were analyzed using the area under the receiver operating characteristic curve (AUROC) for prediction of kidney failure.

Results: The cohort included 115 patients (age 64 years, 55% male, 57% myeloperoxidase-ANCA, baseline creatinine 3.6 mg/dL, eGFR 16 mL/min/1.73 m2), with 34 (30%) dialysed within 4 weeks. During a median 6.4-year follow-up, 39 (34%) patients progressed to kidney failure, and 13 (11%) died. Cox analysis identified AKRiS, dialysis within 4 weeks, C3 deposits, renal arteritis on biopsy, lower eGFR after induction and higher UPCR after induction as unadjusted risk factors for kidney failure. After adjusting for AKRiS, dialysis within 4 weeks [hazard ratio (HR) 6.20 (95% confidence interval 2.76 to 13.95), P ≤ .001], eGFR after induction [HR 0.94 (0.89 to 0.99), = .03] and UPCR after induction [HR 1.62 (1.02 to 2.58), = .04] remained significantly associated with kidney outcome. The AUROC for kidney failure prediction was 0.77 for AKRiS, increasing to 0.82, 0.80 and 0.79 when adding dialysis within 4 weeks, eGFR and UPCR after induction, respectively.

Conclusion: Dialysis within 4 weeks, eGFR after induction and UPCR after induction are able to predict long-term kidney outcome in AAV patients. Adjusting AKRiS for these variables modestly enhances its predictive power. We propose using them as placeholder endpoints for kidney failure in future studies.

预测anca相关性血管炎伴肾脏受累的预后。
背景:ANCA肾脏风险评分于2023年更新为ANCA肾脏风险评分(AKRiS),以改善抗中性粒细胞胞质抗体(ANCA)相关血管炎(AAV)和肾脏累及患者的临床病理预后。我们的研究旨在评估在我们的多中心队列中,纳入最近确定的AAV肾脏生存预测因子是否可以进一步提高AKRiS的预后准确性。方法:回顾性分析2005年至2020年所有肾活检的AAV事件。Cox回归分析检查了与肾衰竭相关的因素[AKRiS, 4周内透析,尿蛋白-肌酐比(UPCR)和基线血尿,C3沉积,活检时肾动脉炎,估计肾小球滤过率(eGFR), UPCR和诱导后血尿]。使用受试者工作特征曲线下面积(AUROC)预测肾衰竭,对这些因素与AKRiS结合进行分析。结果:该队列包括115例患者(年龄64岁,55%为男性,57%为髓过氧化物酶- anca,基线肌酐3.6 mg/dL, eGFR 16 mL/min/1.73 m2),其中34例(30%)在4周内透析。在中位6.4年的随访期间,39名(34%)患者进展为肾衰竭,13名(11%)患者死亡。Cox分析发现,AKRiS、4周内透析、C3沉积、活检后肾动脉炎、诱导后较低的eGFR和诱导后较高的UPCR是肾衰竭的未调整危险因素。调整AKRiS后,4周内透析[风险比(HR) 6.20(95%可信区间2.76 ~ 13.95),P≤0.001],诱导后eGFR [HR 0.94 (0.89 ~ 0.99), P = 0.03]和诱导后UPCR [HR 1.62 (1.02 ~ 2.58), P = 0.04]仍与肾脏预后显著相关。AKRiS预测肾衰竭的AUROC为0.77,在诱导后4周内增加透析,eGFR和UPCR分别增加到0.82、0.80和0.79。结论:4周内透析、诱导后eGFR和诱导后UPCR能够预测AAV患者的长期肾脏预后。适度调整这些变量的AKRiS可增强其预测能力。我们建议在未来的研究中使用它们作为肾衰竭的占位终点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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