Abstract: SA-PO668
Clinical Features and Outcomes in Anti-Glomerular Basement Membrane Glomerulonephritis Patients with Onset of Noninfectious Fever
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
- Shi, Xiaoxiao, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
- Xu, Lei, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
- Yin, Huanhuan, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
- Wen, Yu bing, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
- Li, Xuemei, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
- Chen, Limeng, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, BEIJING, China
Background
To summarize the clinical features and outcomes of anti-glomerular basement membrane (anti-GBM) glomerulonephritis (GN) with onset of non-infectious fever.
Methods
We retrospectively reviewed the clinical records and follow-up data of 58 patients with anti-GBM GN in our hospital from May 2010 to May 2019.
Results
Among the 58 anti-GBM GN patients, 39 patients (67.2%) presented with fever initially. After careful screening of serological and urinary tests, pathogenic cultures, and CT scans, 28 (48.3%) patients had no evidence of infections. These non-infectious febrile patients had a female/male ratio of 1.3:1, and the average age was 46±18 years old. Six (21.4%) patients were complicated with pulmonary hemorrhage. Compared to the non-febrile anti-GBM GN patients (n=19), they showed higher CRP levels (65.4 vs. 24.5 mg/L, P=0.045) and higher anti-GBM antibody titers (175±41 vs. 132±62 EU/ml, P=0.012). In kidney, they presented milder proteinuria (2.51±2.51 vs. 4.69±2.41 g/d, P=0.016), despite similar serum creatinine (906±414 vs. 995±604 μmol/L) and eGFR (4.66 vs. 4.40 mL/min/1.73m2) levels (P>0.05). Crescentic GN was diagnosed in 11 (84.6%) of 13 patients who had renal biopsy. At onset, 82.1% patients were treated by antibiotics which didn't work. All patients received immunosuppressive treatment later, and 26 of them had combined plasma exchange therapy. They received more plasma exchanges (7.2±3.9 vs. 4.0±3.5, P=0.006) and had a longer hospital stay (42±21 vs. 29±15 days, P=0.020) compared to the non-febrile group. During follow-up, the renal survival rate at 1, 3 and 5 year was 20.8%, 13.6% and 10.0%, which were similar with the non-febrile group (18.8%, 7.1%, 0%) (P>0.05). Among all the 58 anti-GBM GN patients, Kaplan-Meier survival analysis showed that oliguria, pulmonary hemorrhage, initial eGFR, and anti-GBM antibody titers were prognostic factors for renal outcome (P<0.05), but fever was not a predictor of it. Multivariate Cox regression analysis showed higher initial eGFR was an independent risk factor for ESRD (RR=0.80, 95%CI (0.69, 0.93), P=0.004).
Conclusion
Fever in anti-GBM GN may be part of systemic inflammations instead of infections. Anti-GBM GN patients with onset of non-infectious fever presented more severe systemic inflammations and needed more intensive treatment.