Abstract: SA-PO650
Absence of Fibrinoid Necrosis in ANCA-Glomerulonephritis Is Associated with Increased Risk of Vasculitis Relapses
Session Information
- Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1203 Glomerular Diseases: Clinical, Outcomes, and Trials
Authors
- Augusto, Jean francois, CHU Angers, Angers, France
- Wacrenier, Samuel, CHU Angers - CH Le Mans, Angers, France, France
- Piccoli, Giorgina B., University of Torino, Torino, Italy
- Brilland, Benoit, CHU d'Angers, Angers, France
- Subra, Jean-Francois, CHU Angers, Angers, France
- Garnier, Anne-Sophie, Angers University Hospital, Angers, France
Background
Fibrinoid necrosis (FN) is a cornerstone lesion of ANCA-associated glomerulonephritis (ANCA-GN). However, its significance in kidney biopsy of ANCA-GN patients has not yet been fully established. The objective of the present study was to analyze its association with baseline characteristics and outcomes of ANCA-GN patients.
Methods
All consecutive AAV patients diagnosed between 2000 and 2018 from the Maine-Anjou ANCA-associated vasculitis (AAV) registry with a contributive kidney biopsy showing pauci-immune glomerulonephritis at onset or relapse of AAV were included in the present study. Among the 146 patients on the registry, 116 patients fulfilled the inclusion criteria and were analyzed.
Results
Patients were predominatly males with a mean age of 63.7 years-old and a mena eGFR at diagnosis of 33.1mL/min/1.73m2 .FN was detected at kidney biopsy in 42.2% of patients.Patients with FN had lower eGFR (p=0.008), needed more frequently renal replacement therapy at kidney biopsy (p=0.018) and had a lower rate of AAV relapse (p=0.005) as compared to patients without FN. Attack and maintenance regimen, and extra-renal involvment was not significantly different between groups. FN was not significantly associated with other glomerular lesions. Relapse-free survival was significantly higher in patients with FN at biopsy, as was the survival-free of major and renal relapses. Univariate analysis showed granulomatosis with polyangiitis (GPA; HR 2.32, p=0.045), ear-nose-throat involvement (HR 2.47, p=0.032) and absence of FN (HR 3.35, p=0.027) to be significant risk factors of relapse. In multivariate Cox analysis, absence of FN at kidney biopsy conferred a 3-fold increased risk of developing relapse, after adjustment for other risk factors.
Conclusion
FN could be a reliable marker to assess the risk of AAV relapse and we propose that it should be evaluated as a tool to manage immunosuppressive regimen, especially in the long term.
Relapse-free survival according to FN status