Publicação
Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression?
| Resumo: | ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations. |
|---|---|
| Autores principais: | Nogueira,Rui Filipe |
| Outros Autores: | Oliveira,Nuno Afonso; Gaudêncio,Margarida; Belmira,Ana; Alves,Rui |
| Assunto: | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| Ano: | 2022 |
| País: | Portugal |
| Tipo de documento: | artigo |
| Tipo de acesso: | acesso aberto |
| Instituição associada: | Fundação para a Ciência e Tecnologia |
| Idioma: | inglês |
| Origem: | SciELO Portugal |
| _version_ | 1868441695963578368 |
|---|---|
| author | Nogueira,Rui Filipe |
| author2 | Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
| author2_role | author author author author |
| author_facet | Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
| author_role | author |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Nogueira,Rui Filipe\"},{\"Person.name\":\"Oliveira,Nuno Afonso\"},{\"Person.name\":\"Gaudêncio,Margarida\"},{\"Person.name\":\"Belmira,Ana\"},{\"Person.name\":\"Alves,Rui\"}] |
| datacite.creators.creator.creatorName.fl_str_mv | Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| datacite.titles.title.fl_str_mv | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| dc.creator.none.fl_str_mv | Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
| dc.format.none.fl_str_mv | text/html |
| dc.identifier.none.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
| dc.language.none.fl_str_mv | eng |
| dc.publisher.none.fl_str_mv | Sociedade Portuguesa de Nefrologia |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.source.none.fl_str_mv | Portuguese Journal of Nephrology & Hypertension v.36 n.4 2022 |
| dc.subject.none.fl_str_mv | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| dc.title.fl_str_mv | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations. |
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| identifier.url.fl_str_mv | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
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| institution | Fundação para a Ciência e Tecnologia |
| instname_str | Fundação para a Ciência e Tecnologia |
| language | eng |
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| person_str_mv | Nogueira,Rui Filipe Oliveira,Nuno Afonso Gaudêncio,Margarida Belmira,Ana Alves,Rui |
| publishDate | 2022 |
| publisher.none.fl_str_mv | Sociedade Portuguesa de Nefrologia |
| reponame_str | SciELO Portugal |
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| spelling | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression?Nogueira,Rui FilipeOliveira,Nuno AfonsoGaudêncio,MargaridaBelmira,AnaAlves,RuiAnti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosisAnti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapyGlomerulonephritisImmunosuppression TherapyRenal Dialysisopen accesshttp://purl.org/coar/access_right/c_abf2http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223URLhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223URLHasVersion2022-12-01ABSTRACT Introduction: ANCA associated vasculitis commonly affects the kidneys. The intense inflammatory damage disrupts the glomerular architecture. Induction immunosuppressive therapy is responsible for a large part of the morbidity and mortality of these patients, due to infectious complications. This highlights the importance of defining risk factors associated with a worse renal prognosis in order to select the patients who would benefit the most from immunosuppressive therapy when it comes to renal limited vasculitis. Methods: Retrospective collection of data from patients admitted to the Coimbra’s University Hospital Nephrology Department with the diagnosis of de novo ANCA vasculitis, between 01-06-2009 and 01-06-2019. Data were analysed with SPSS v26® using parametric and nonparametric tests, Kaplan Meyer survival and ROC curve analysis. Results: There were 81 cases of de novo vasculitis, mainly due to anti-MPO antibody associated vasculitis (N=69; 85.2%). Mean age at diagnosis was 67.4 ± 15.7 years and most patients were male (N=47; 58%). At admission, patients had a mean serum creatinine (sCr) of 6.8 ± 4.0 mg/dL. Dialysis was required in 23 (28.4%) patients at admission and 44.4% were dependent on renal replacement therapy at discharge. Among dialysis-dependent patients at discharge treated with immunosuppression for at least 3 months (N=15) we observed partial kidney recovery in 2 (13.3%). Deaths were mostly (N=8/11; 72.7%) caused by infections. Discussion: Our results call into question the need for aggressive induction treatment in dialysis-dependent patients without extrarenal manifestations.Sociedade Portuguesa de NefrologiaPortuguese Journal of Nephrology & Hypertension v.36 n.4 2022text/htmlengjournal articlehttp://purl.org/coar/resource_type/c_6501literature |
| spellingShingle | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? Nogueira,Rui Filipe Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| status | SINGLETON |
| subject.fl_str_mv | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| title | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| title_full | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| title_fullStr | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| title_full_unstemmed | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| title_short | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| title_sort | Dialysis Dependency at Discharge in De Novo ANCA Associated Renal Limited Vasculitis: Should We Avoid Further Immunosuppression? |
| topic | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| topic_facet | Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/ therapy Glomerulonephritis Immunosuppression Therapy Renal Dialysis |
| url | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400223 |
| visible | 1 |