Clinicopathological Characteristics and Influencing Factors of Renal Vascular Lesions in Anti-neutrophil Cytoplasmic Autoantibody-Related Renal Vasculitis.

Ruiqiang Wang,Ningning Guo,Jin Wang,Xiaofeng Zhang,Yuanyuan Guo,Lin Tang,Yunqi Wu,Dongyue An

doi:10.3389/fmed.2021.710386

Abstract

The purpose of this study was to evaluate the clinicopathological features of different degrees of extraglomerular renal vascular lesions (RVLs) in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis and explore their clinical determinants. This is a retrospective study of 186 patients with ANCA-associated renal vasculitis diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2014 to April 2019. The patients who met the inclusion criteria were divided into non-renal RVLs, mild RVLs, moderate RVLs, and severe RVLs. It was found that there were significant differences in serum creatinine (SCR), estimated glomerular filtration rate (eGFR), erythrocyte sedimentation rate (ESR), high-density lipoprotein (HDL), systolic blood pressure (SBP), the prevalence rate of hypertension, the proportion of normal glomeruli, and the proportion of sclerotic glomeruli and interstitial fibrosis integral. SCR and ESR are independent risk factors for RVLs. The participants were followed up for 1 year, and the progression to end-stage renal disease (ESRD) and death was defined as endpoint events. We found that the survival rate of patients without RVLs was significantly higher than that of patients with RVLs and that the RVLs were an independent risk factor for ESRD or death. Early intervention in the progression of RVLs can improve the prognosis.

Highlights

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) refers to a group of multisystem disorders characterized by necrotizing inflammation and destruction of small- and medium-sized blood vessels in conjunction with anti-neutrophil cytoplasmic antibody (ANCA)
Age, gender, the prevalence of hypertension, diabetes mellitus (DM), cardiovascular diseases, systolic blood pressure (SBP), diastolic blood pressure (DBP), leukocyte count (WBC), hemoglobin (HB), platelet count (PLT), serum creatinine (SCR), serum uric acid (UA), estimated glomerular filtration rate, serum albumin (ALB), 24 h-proteinuria (24 h-TP), urine RBC count, total cholesterol (T-CHO), triglycerides (TGs), highdensity lipoprotein (HDL), low-density lipoprotein (LDL), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), complement C3, complement C4, immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), myeloperoxidase antibody, protease 3 antibody, and the Birmingham Vasculitis Activity Score (BVAS). eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation
One hundred eighty-six patients with ANCA-associated renal vasculitis were enrolled in this study

Summary

Introduction

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) refers to a group of multisystem disorders characterized by necrotizing inflammation and destruction of small- and medium-sized blood vessels in conjunction with ANCA. The classification is based only on glomerular lesions, and parameters of renal interstitial vascular lesions are excluded. AAV involves systemic small vessels, and it is important to assess the damage to extraglomerular vascular lesions. In this retrospective observational study, we indicated and graded the severity of vascular lesions using a semi-quantitative scoring system [6] and further assessed their associations with clinical and pathological indexes and their influencing factors in patients with ANCA-associated renal vasculitis, providing a reference for delaying the progression and improving prognosis

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