ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO647

Impact of Immunosuppressive Therapy on Vascular and Vasogenic Alterations of the Central Nervous System in Patients With ANCA-Associated Vasculitis With Renal Involvement

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Lubas, Arkadiusz, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
  • Maliborski, Artur, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
  • Grzywacz, Anna, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
  • Splocharski, Grzegorz, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
  • Niemczyk, Stanislaw, Wojskowy Instytut Mediczny, Warszawa, Mazowieckie, Poland
Background

The data concerning the prevalence of CNS vasculitis in patients with ANCA-associated vasculitis (AAV) with renal involvement is limited. Moreover, the efficacy of systemic immunosuppressive therapy (IS) on CNS alterations in this population of patients was not clearly evidenced. This study aimed to prospectively estimate the occurrence of CNS vascular alterations and the influence of 1-year IS in patients with AAV with renal involvement.

Methods

Patients with acute onset of AAV with renal involvement qualified for the intensive IS were prospectively included in the study. As the treatment, an induction and a maintenance IS were provided. BVAS, creatinine, MPO-ANCA, PR3-ANCA, and non-contrast brain MRI angiography were estimated initially and after 12 months. Vascular alterations in the form of alternating narrowing and dilatation (aND) in secondary and tertiary cerebral artery branches (CAB) were investigated. Moreover, the number of focal ischemic white matter lesions (WML) was estimated. McNamara test was used to compare dependent categorical variables and Wilcoxon’s test for continuous dependent variables comparison.

Results

In total, 17 patients who completed both brain MRI assessments were included in the study.
Initially, aND was found in 12/17 (70.5%) patients, but after treatment, these alterations were investigated in 7/12 (41.2%) participants (p=0.074). In the secondary CAB IS resulted in 50% decrease of aND (10/17 vs. 5/17; p=0.074). Moreover, the reduction of aND in tertiary CAB was significant (9/17 (52.9%) vs. 3/17 (17.6%); p=0.041). In all participants, WML were detected before and after the IS, and the IS did not change the number of these lesions. A significant decrease in BVAS (7.76 ±3.49 vs. 0.65 ±0.86; p<0.001) and MPO-ANCA (60.2 ±46.5 vs. 24.5 ±36.0 p<0.001) after IS was investigated. The decrease of creatinine and PR3-ANCA was not important.

Conclusion

The occurrence of brain vasculitis lesions is frequent in patients with a flare of ANCA-associated vasculitis with renal involvement. Immunosuppressive treatment decreases CNS vascular alterations, which corresponds with the decrease of MPO-ANCA and clinical activity of the disease.

Funding

  • Government Support – Non-U.S.