Kidney Week

Abstract: SA-PO746

Prediction of Recovery of Kidney Function in Severe ANCA-Associated Glomerulonephritis

Session Information

• ANCA-Associated Vasculitis, Anti-GBM Disease, and Other RPGN
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Leffek, Megan, The University of Manchester, Manchester, United Kingdom

Megan Leffek, MBChB

• Gulati, Kavita, Imperial College London, London, United Kingdom

Kavita Gulati, MBChB

• Scott, Jennifer, The University of Dublin Trinity College, Dublin, Ireland

Jennifer Scott, MBChB

• Chapman, Gavin, University of Ediburgh, Edinburgh, United Kingdom

Gavin Chapman, MBChB

• Brilland, Benoit, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France

Benoit Brilland, MD, PhD

• Barnini, Cecilia, University Innsbruck, Innsbruck, Austria

Cecilia Barnini, MD

• Kratky, Vojtech, Prague City University a s, Praha, Praha, Czechia

Vojtech Kratky, MD

• Rathmann, Jens, Lunds Universitet, Lund, Sweden

Jens Rathmann, MD, PhD

• Kim, Minhyung, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Minhyung Kim, MD

• Ooi, Li Jin, Manchester University NHS Foundation Trust, Manchester, United Kingdom

Li Jin Ooi

• Hruskova, Zdenka, Prague City University a s, Praha, Praha, Czechia

Zdenka Hruskova

• Stangou, Maria J., Aristoteleio Panepistemio Thessalonikes, Thessalonike, Kentrikḗ Makedonía, Greece

Maria J. Stangou, MD, PhD

• Dhaygude, Ajay Prabhakar, Royal Preston Hospital, Preston, United Kingdom

Ajay Prabhakar Dhaygude, MD, FASN

• Yildiz, Abdulmecit, Bursa Uludag Universitesi, Nilufer, Bursa, Turkey

Abdulmecit Yildiz, MD

• Augusto, Jean Francois, Centre Hospitalier Universitaire d'Angers, Angers, Pays de la Loire, France

Jean Francois Augusto, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Hinojosa-Azaola, Andrea, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Andrea Hinojosa-Azaola, MSc

• Mejia-Vilet, Juan M., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de Mexico, Ciudad de México, Mexico

Juan M. Mejia-Vilet, MD, MS, PhD

• Kronbichler, Andreas, University Innsbruck, Innsbruck, Austria

Andreas Kronbichler, MD, PhD

• Dhaun, Neeraj, University of Ediburgh, Edinburgh, United Kingdom

Neeraj Dhaun, MD, PhD, FASN

• Segelmark, Marten, Lunds Universitet, Lund, Sweden

Marten Segelmark, MD, PhD

• Little, Mark Alan, The University of Dublin Trinity College, Dublin, Ireland

Mark Alan Little, MBChB, PhD

• Geetha, Duvuru, John Hopkins University, Baltimore, Maryland, United States

Duvuru Geetha, MD, FASN

• McAdoo, Stephen Paul, Imperial College London, London, United Kingdom

Stephen Paul McAdoo, MA, MBBS, PhD

• Brix, Silke R., The University of Manchester, Manchester, United Kingdom

Silke R. Brix, MD

Group or Team Name

• AKRiS Working Group.

Background

Anti-neutrophil cytoplasmic antibody (ANCA) vasculitis often involves the kidneys and kidney failure confers significant morbidity and mortality. An improved prognostication of kidney function recovery will enable tailoring treatment to patients’ needs.

Methods

Multicentre, retrospective analysis of newly diagnosed ANCA glomerulonephritis (GN) patients requiring kidney replacement therapy (KRT) at time of diagnosis of 16 registries and vasculitis referral centres. Unadjusted and adjusted multivariable Cox regression for primary outcome of kidney function recovery.

Results

372 patients required KRT at time of diagnosis and 137 of these recovered kidney function during follow-up (36.8%). The median age was 67 years (interquartile range, IQR, 56 – 74 years) and 57.4% were male. 159 patients were anti-myeloperoxidase positive (42.7%), 174 patients were anti-proteinase 3 positive (46.8%), and 39 patients were ANCA negative (10.5%). Median creatinine and estimated glomerular filtration rate (eGFR) at time of diagnosis were 618mmol/l (IQR 470 – 844mmol/l) and 6.2mls/min (IQR 4.7 – 9mls/min). 243 patients developed ESKD (65.3%) during median follow-up of 3.6 years (IQR 0.6 – 6.2 years). 120 patients died during follow-up (32.3%).

Patients recovering kidney function showed a median of 22.8% normal and 33.5% crescentic glomeruli, patients remaining KRT-dependent demonstrated a median of 5.7% normal and 27.3% crescentic glomeruli in their biopsies. The percentage of normal glomeruli, interstitial fibrosis and tubular atrophy (IFTA), creatinine and eGFR associated with kidney function recovery. In a multivariable adjusted analysis, the percentage of normal glomeruli and creatinine correlated with outcome (p<0.001, p<0.001, respectively) while antibody subtype and diagnosis did not.

Conclusion

Kidney function and the percentage of normal glomeruli were predictive of kidney function recovery in patients with newly diagnosed ANCA GN requiring KRT. The percentage of crescentic glomeruli did not differ between patients recovering from kidney failure and patients remaining on KRT.

Funding

• Government Support – Non-U.S.