ANCA血管炎并发严重肾脏疾病的性别特异性临床表现和结局

IF 5.6
Marta Casal Moura, Marc Patricio Liebana, Ladan Zand, Dalia Zubidat, Maria J Vargas-Brochero, Daniela Valencia, Miriam Machado, Sana Abouzahir, Ulrich Specks, Sanjeev Sethi, Fernando C Fervenza, Maria José Soler
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引用次数: 0

摘要

背景:性别对抗中性粒细胞胞质抗体(ANCA)相关血管炎(AAV)合并肾小球肾炎(AAV- gn)患者的临床表现和预后的影响尚未研究,特别是在出现时肾脏严重受损伤的患者(eGFR方法:对MPO-或PR3-ANCA阳性的AAV (MPA或GPA)和eGFR患者进行回顾性队列研究结果:我们分析了166例活检证实AAV- gn和eGFR活跃的患者在我们的队列中,男性患者表现出更高的SCr,并且在前4周内开始透析的频率更高(53.4%比30.7%)。在AAV-GN和eGFR患者中,肾脏恢复、总透析率和12个月内进展为ESKD的结果没有差异
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sex-specific clinical presentations and outcomes in ANCA vasculitis presenting with severe kidney disease.

Background: The impact of sex in the clinical presentation and outcomes of patients with anti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) with glomerulonephritis (AAV-GN) has not been studied, particularly in patients with severe kidney involvement at presentation (eGFR < 15 mL/min/1.73m2).

Methods: A retrospective cohort study on MPO- or PR3-ANCA positive patients with AAV (MPA or GPA) and eGFR<15 ml/min/1.73m2 or end-stage kidney disease (ESKD) at presentation. Clinical presentation and renal outcomes were analyzed according with sex.

Results: We analyzed 166 patients with biopsy proven active AAV-GN and eGFR < 15 mL/min/1.73m2 at the time of diagnosis: 78 (47%) were females and 88 (53%) were males. Hypertension was more frequently present in males (85.2% vs.70.5%, P = 0.022). Median serum creatinine (SCr) was higher in males when compared with females (5.2 [IQR 4.2-7.4] vs. 3.6 [IQR 2.8-5.1]mg/dL, P < 0.001). There were no statistically significant differences in the median percentage of crescents. However, the rate of dialysis initiation or progression to ESKD in the first 12 months was not different between males (15, 62.5%) versus females (29, 61.7%) at 12 months. By multivariable logistic regression, factors related with dialysis initiation within the first 4 weeks in our cohort were SCr, alveolar hemorrhage, and PR3-ANCA adjusted for sex.

Conclusion: In our cohort, male patients presented with higher SCr, and dialysis was started within the first 4 weeks more frequently (53.4% vs. 30.7%). There were no differences in outcomes of kidney recovery, overall dialysis rates, and progression to ESKD within 12 months in patients with AAV-GN and eGFR < 15 mL/min/1.73m2 between groups.

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