J Korean Med Sci.  2016 Apr;31(4):542-546. 10.3346/jkms.2016.31.4.542.

Long-term Prognosis of Anti-Neutrophil Cytoplasmic Antibody-Negative Renal Vasculitis: Cohort Study in Korea

• Lee SW
• Yu MY
• Baek SH
• Ahn SY
• Kim S
• Na KY
• Chae DW
• Chin HJ

• KMID: 2363692
• DOI: http://doi.org/10.3346/jkms.2016.31.4.542

Abstract

Few studies have reported on the long-term prognosis of anti-neutrophil cytoplasmic antibody (ANCA)-negative renal vasculitis. Between April 2003 and December 2013, 48 patients were diagnosed with renal vasculitis. Their ANCA status was tested using indirect immunofluorescence and enzyme-linked immunosorbent assays. During a median (interquartile range) follow-up duration of 933.5 (257.5-2,079.0) days, 41.7% of patients progressed to end stage renal disease (ESRD) and 43.8% died from any cause. Of 48 patients, 6 and 42 were ANCA-negative and positive, respectively. The rate of ESRD within 3 months was higher in ANCA-negative patients than in ANCA-positive patients (P = 0.038). In Kaplan-Meier survival analysis, ANCA-negative patients showed shorter renal survival than did ANCA-positive patients (log-rank P = 0.033). In univariate Cox-proportional hazard regression analysis, ANCA-negative patients showed increased risk of ESRD, with a hazard ratio 3.190 (95% confidence interval, 1.028-9.895, P = 0.045). However, the effect of ANCA status on renal survival was not statistically significant in multivariate analysis. Finally, ANCA status did not significantly affect patient survival. In conclusion, long-term patient and renal survival of ANCA-negative renal vasculitis patients did not differ from those of ANCA-positive renal vasculitis patients. Therefore, different treatment strategy depending on ANCA status might be unnecessary.

Keyword

Anti-Neutrophil Cytoplasmic Antibody (ANCA); Kidney Failure, Chronic; Vasculitis; Mortality; Sex; Proteinuria; Koreans; Prognosis; Survival; Cohort Studies

MeSH Terms

Age Factors
Aged
Antibodies, Antineutrophil Cytoplasmic/*analysis
Cohort Studies
Enzyme-Linked Immunosorbent Assay
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Kidney Diseases/*diagnosis/mortality
Kidney Failure, Chronic/etiology
Male
Microscopy, Fluorescence
Middle Aged
Prognosis
Proportional Hazards Models
Republic of Korea
Retrospective Studies
Risk Factors
Severity of Illness Index
Sex Factors
Vasculitis/complications/*diagnosis/mortality
Antibodies, Antineutrophil Cytoplasmic

Figure

• 

  Fig. 1 Kaplan-Meier survival curves according to anti-neutrophil cytoplasmic antibody anti-neutrophil cytoplasmic antibody (ANCA) status. Renal and patient survival are shown in (A) and (B), respectively. The gray and black lines represent ANCA-negative and positive groups, respectively.

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