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Abstract: SA-PO406

Clinical and Therapy Related Risk Factors for Survival in ANCA-Associated Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Brix, Silke R., University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • Wunsch, Verena, University of Hamburg, Hamburg, Germany
  • Arici, Silay, University of Hamburg, Hamburg, Germany
  • Busch, Martin, University Hospital Jena, Jena, Germany
  • Nitschke, Martin, University of Lübeck, Lübeck, Germany
  • Jabs, Wolfram J., Vivantes, Berlin, Germany
  • Huber, Tobias B., University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • Panzer, Ulf, University Hospital Hamburg-Eppendorf, Hamburg, Germany
  • Stahl, Rolf A., University Hospital Hamburg-Eppendorf, Hamburg, Germany
Background

Renal involvement and infectious complications have great impact on mortality in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.

Methods

We retrospectively investigated a multicenter ANCA-associated glomerulonephritis (GN) cohort for clinical and therapy related factors associated with relapse, end stage renal disease (ESRD) and survival in these patients.

Results

In 270 patients with a newly diagnosed, biopsy proven ANCA-associated necrotizing crescentic GN, the most sensitive markers for mortality were age and development of ESRD (p<0.0001, respectively). Gender, antibody and disease subtype did not influence patient survival. Patients with renal limited disease had the same renal and overall survival compared to patients with multi-organ involvement, e.g. patients with pulmorenal syndrome. Patients who were dialysis dependent at the time of diagnosis had a higher mortality during follow up (p<0.05). There was no difference in mortality between cyclophosphamide and rituximab treated patients. In the elderly population (age ≥ 70 years; n=84), a sub-cohort was given a reduced induction immunosuppression (4-6 cycles of 500mg; n=29). These patients had a higher rate of survival (p<0.05) compared to elderly patients with a regular cyclophosphamide induction while no differences in dialysis dependence or relapses were detected.

Conclusion

Our data suggest that a reduced induction immunosuppression in elderly patients may be appropriate, as this population seems not to benefit from a higher cyclophosphamide induction dosage.

Funding

  • Government Support - Non-U.S.