Clinical and pathological characteristics of pauci-immune renal vasculitis in Mexico: Report of 23 cases

Abstract

Abstract Introduction Antineutrophil cytoplasmic antibodies (ANCA) vasculitis often involves a kidney with a poor short-term prognosis. A short series of cases are presented that were treated from 2008 to 2012 in a third level hospital. Emphasis is placed on the clinical and pathological characteristics of their presentation in the emergency room, and the fact that there are no publications of a series of cases of ANCA-associated renal vasculitis. Objective To describe the clinical outcome of ANCA-associated vasculitis in a Mexican population. Materials and methods A retrospective descriptive study was conducted on 23 cases of vasculitis with renal involvement. Results The study included 13 women and 10 men, with a ratio of 1.3:1, with a mean age of 47±16 years, in which 21.7% had a history of diabetes, 26% with hypertension, and 8.7% with a history of autoimmune disease. The mean duration of renal symptoms was 2.8±2.2 months, with a mean creatinine of 8.0±6.3 mg/dl. The mean glomerular filtration rate was 7 ml/min/m2 at admission. All (100%) of the patients had microhaematuria, and 20.9±12.2% of the patients showed dysmorphism. It is important to note that 30% of pulmonary vasculitis, 21.7% cutaneous vasculitis, and digestive tract were documented. Approximately two-thirds (65%) required renal replacement therapy on admission, a figure that remained 12 months later. There were 3 deaths associated with the activity of uncontrollable vasculitis, and only 21.7% of the patients remained free of renal replacement therapy, but with a significant deterioration in renal function at 12 months post-event. Conclusions ANCA associated renal vasculitis has a poor short-term prognosis, and survival is closely related to the time of evolution of the disease activity and its appropriate immunosuppressive intervention.