Patients' and Renal Survival in ANCA-associated Vasculitis and Glomerulonephritis

Han, S Y; Kwon, Y J; Jo, S K; Shin, J H; Cha, D R; Cho, W Y; Pyo, H J; Kim, H K; Yoon, S Y

Abstract

ANCA-associated vasculitis and glomerulonephritis encompasses a variety of conditions such as Wegener's granulomatosis(WG), microscopic polyangiitis (MP), Churg-Strauss syndrome(CS) and renal-limited vasculitis[pauciimmune necrotizing cre sctric glomerulonephritis(NCGN)]. To analyze risk factors for poor patient survival and renal remission, we examed sixteen patients diagnosed as ANCA-associated vasculitis and glomerulonephritis according to age, ANCA, extrarenal vasculitis and a presenting serum creatinine level. Diagnosis of sixteen patients(male 10/ female 6, mean age 51.2 years, range 21-74 years) were 5 WG, 4 MP, 1 CS, and 6 NCGN. Ten patients were ANCA positive(c-ANCA 5, p-ANCA 5) and six patients were ANCA negative. Six patients showed extrarenal vasculitis, especially lung involvement. The median value of a presenting serum creatinine was 4.55mg/dl(range 0.3-18mg/dl). According to age, older patients than 60 years(n=7) are at greater risk than younger patients in patient survival(n=9)(P= 0.01). In patient survival and renal remission, patients who present serum creatinine above 4.55mg/ dl(n=8) are at greater risk than below(n=8)(P=0.018, P=0.02). The other factors such as ANCA and extrarenal vasculitis did not influence on patient survival and renal remission. In conclusion, the poor prognostic factors were older age above 60 years of age and a presenting serum creatinine level above 4.55mg/dl. Therefore, patient survival and renal remission appear to have improved with early diagnosis and early recognition of disease activity before serum creatinine rises.