Abstract
Renal involvement is a common and severe complication of AAV as it can cause ESRD. Histopathological subgrouping and ARRS are helpful to predict long-term ESRD in patients with AAV. Because a subgroup of critically ill patients with severe AAV present with deterioration of kidney function requiring RRT at admission, we here aimed to evaluate histopathological findings and predictive value of Berden's histopathological subgrouping and ARRS for severity of AKI and requirement of RRT during the short-term clinical course in critically ill patients requiring intensive care treatment and predictors for short-term renal recovery in patients requiring RRT. A subgroup of 15/46 (32. 6%) AAV patients with biopsy-proven AAV required RRT during the short-term course of disease, associated with requirement of critical care treatment. While histopathological subgrouping and ARRS were associated with requirement of acute RRT, presence of global glomerular scarring was the strongest predictor of failure to recover from RRT after initiation of remission induction therapy. This new aspect requires further investigation in a prospective controlled setting for therapeutic decision making especially in this subgroup.
Highlights
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic vasculitis, which most frequently presents as microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) [1]
Since severity of AKI, requirement of renal replacement therapy (RRT), and short-term renal recovery in critically ill patients are associated with disease severity and clinical course of disease, predictors for RRT requirement and renal recovery after initiation of remission induction therapy are of relevance [6]
Histopathological subgrouping and ANCA renal risk score (ARRS) are helpful for risk stratification to predict long-term renal survival rates [4, 5]
Summary
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic vasculitis, which most frequently presents as microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA) [1]. Unlike Berden’s classification, Brix et al suggested the ANCA renal risk score (ARRS) by incorporation of the baseline glomerular filtration rate (GFR) to the histopathological findings (percentage of normal glomeruli, tubular atrophy/interstitial fibrosis) to predict ESRD in patients with AAV [5]. Renal Recovery in Severe AAV (AKI) required renal replacement therapy (RRT) during the initial course of the disease [4, 5]. Since severity of AKI, requirement of RRT, and short-term renal recovery in critically ill patients are associated with disease severity and clinical course of disease, predictors for RRT requirement and renal recovery after initiation of remission induction therapy are of relevance [6]. We here aimed to evaluate the histopathological findings and predictive value of Berden’s histopathological subgrouping and ARRS for severity of AKI and requirement of RRT during the short-term clinical course in critically ill patients requiring intensive care treatment. We sought to identify predictors for short-term renal recovery in patients requiring RRT
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