MP233RENAL SURVIVAL IN PATIENTS WITH ANCA ASSOCIATED VASCULITIS

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INTRODUCTION AND AIMS: ANCA associated vasculitis (AAV) still present a challenge to the clinicians in terms of both understanding etiopathogenesis as well as determining prognostic factors for renal and patient survival. In recent years many clinical, serological and histopathological factors were shown to be significant in terms of renal survival. Our aim was to evaluate significance of clinical and histopathological factors, as well as phenotypes for renal outcome in AAV patient cohort from our center. METHODS: Retrospective study included 81 consecutive patients diagnosed with AAV and pauci-immune crescentic glomerulonephritis from January 2005. to December 2013. We performed renal biopsy on patients using automatic 16 Gauge needle. Light, immunofluorescent and electronic microscopy were performed. Primary outcome was progression to end-stage renal disease (ESRD), defined as persistent (more than three months) need for renal replacement therapy or permanent reduction of EGFR to <15ml/minute (according to CKD EPI formula). Kaplan Meyer survival analysis and multivariate Cox proportional hazard regression analysis were used to explore difference between phenotypes and finding significant predictors regarding outcome. RESULTS: 29.6% of the patients reached ESRD during follow-up. Overall, renal survival was 77.3% and 68.9% at 6 and 36 months of follow-up. Kaplan-Meier survival analysis found no difference between clinical, serological and pathohistological phenotypes for this endpoint-free survival even though there was a tenedency towards patients with crescentic class (according to Berden classification) having worse renal survival compared to combined focal and mixed class (p=0.06). On unadjusted Cox proportional hazards regression analysis, higher BVAS, higher baseline maximal serum creatinine, higher CRP, anaemia, need for plasmapheresis (PLEX) and acute haemodialysis (HD) were associated with that outcome. On multivariate adjusted analysis, anaemia (HR 0.97, 95 % CI 0.94-0.99, p=0.041) and the need for acute HD (HR 3.15, 95 % CI 1.20-8.26, p=0.02) remained significantly associated with this endpoint. Sclerotic class was excluded from the analysis of pathohistological phenotypes due to small number of patients and the absence of events. CONCLUSIONS: Individual AAV patients cohorts will always have specific factors playing important role in the renal survival. This could be due to the specificities of the studied population both in terms of disease characteristics but also ethnicity, uniformity of the population and perhaps some yet unknown genetic factors. We believe that, according to our data renal function at presentation and anaemia should be included in prediction models for the renal survival in the AAV patients.

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