Late restoration of renal function in patients with severe ANCA-associated glomerulonephritis who were dialysis-dependent at presentation.

Abstract

In antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), many patients with severe renal dysfunction are on dialysis at presentation. Among those who got rid of dialysis finally, renal restoration happened mostly within the first 3months of treatment. However, in clinical practice, we occasionally encountered patients who got rid of dialysis after 3months. The current study investigated clinical and pathological features of AAV patients with so-called delayed renal function restoration. A total of 156 patients with ANCA-associated glomerulonephritis who were on dialysis at presentation were retrospectively recruited. Clinical and pathological data as well as treatment and outcomes were analyzed. Among these 156 patients, 58 and 12 patients got rid of dialysis within and after 3months, respectively. Among the 12 patients with delayed renal function restoration, 8 and 4 patients got rid of dialysis within and after 6months, respectively. Among the 72 patients who were still on dialysis at the end of 3months since the initiation of immunosuppressive therapy, those receiving intravenous cyclophosphamide therapy over 3months had significantly higher proportion of renal function restoration than those receiving intravenous cyclophosphamide for only 3months (8/14 versus 4/58, P < 0.001). For patients with ANCA-associated glomerulonephritis who were on dialysis at presentation, there is an unnegligible proportion of patients who had their renal function restoration beyond 3months since the initiation of immunosuppressive therapy. Further studies are needed to investigate whether, and for whom, cyclophosphamide prescription should be prolonged for more than 3months.