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Abstract: SA-PO692

Low Chronicity Score at Kidney Biopsy Predicts Renal Recovery From Dialysis in Patients With ANCA-Associated Vasculitis With Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Zubidat, Dalia, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Casal Moura, Marta Isabel Rodrigues, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Patricio-Liébana, Marc, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
  • Soler, Maria Jose, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
  • Dos Santos, Fernanda Geremias, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Nardelli, Luca, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • León Román, Juan Carlos, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain
  • De Sousa, Ciria Leandra Martins, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Zand, Ladan, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Sethi, Sanjeev, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Specks, Ulrich, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
  • Fervenza, Fernando C., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background

Predictors of renal recovery from dialysis after remission-induction therapy in patients with ANCA-associated vasculitis with glomerulonephritis (AAV-GN) are not fully characterized.

Methods

We conducted a retrospective cohort study of MPO- or PR3-ANCA positive patients with AAV (MPA and GPA) and active renal disease requiring dialysis followed between 1996-2021 at two tertiary care centers.

Results

We analyzed 110 patients that needed dialysis and had undergone kidney biopsy at the time of AAV-GN presentation. Seventy-nine patients (71.8%) remained permanently on dialysis, while 31 patients (28.2%) required dialysis only transiently (16 patients received PLEX). There were no differences in severity of the disease as assessed by BVAS/WG (8vs.8 points,p=0.990) nor in eGFR (9.7vs.9.1mL/min/1.73 m2,p=0.902). There were no differences in the activity index on kidney biopsies (assessed by the % of crescents or necrosis/total glomeruli). However, most patients who recovered from dialysis had a minimal/mild chronicity score (64.5vs.39.2%,p<0.0001), whereas patients that remained on dialysis more frequently had moderate/severe chronicity features (60.8vs.35.5%,p<0.0001). There were no differences in the remission-induction immunosuppressants, or use of i.v. methylprednisolone or PLEX. In patients who recovered from dialysis, rituximab was the most frequently used remission-maintenance treatment (42.9vs.10.0%,p=0.005). Mortality was higher in patients who remained on dialysis (35.4vs.12.9%,p=0.019). Minimal/mild scoring of the biopsy was a predictor of recovery from dialysis (OR 2.815;CI95%,1.187-6.675,p=0.019) in univariable analysis. Assuming a p<0.100, we performed a multivariable analysis, and when adjusted to the treatment with PLEX, minimal/mild scoring of the biopsy remained a predictor of recovery from dialysis (OR 2.529;CI95%,1.046-6.118,p=0.040) (Table 1).

Conclusion

In patients with AAV-GN, renal recovery from dialysis depends on the chronicity score of the kidney biopsy at the time of diagnosis and not on the use of PLEX.