Retrospective Analysis Of Clinicopathological And Prognosis Of Patients With ANCA-associated Vasculitis With Kidney Injury

Objective: To analyze the clinicopathological characteristics and prognostic factors of ANCA-associated vasculitis with kidney injury.Methods: A collection of 61 patients diagnosed with ANCA-related vasculitis and renal damage in the Department of Nephrology,First Affiliated Hospital of Fujian Medical University from March 2013 to October 2020,of which 25 cases completed renal biopsy.The general data of 61 patients,the first clinical manifestations,laboratory examinations,prognostic data and the pathological data of 25 renal biopsy patients were collected and statistics.61 patients were divided into p ANCA-positive group and c ANCA-positive group,and the general information,clinical first-onset manifestations,laboratory tests and prognosis between the two groups were compared and analyzed.The 25 patients who completed renal pathological biopsy were compared with p ANCA-positive and c ANCA-positive patients’ glomerular pathological features,and further divided into crescentic nephritis group and non-crescentic nephritis group according to the glomerular pathological features.General data,first clinical manifestations,laboratory examinations and prognosis were compared and analyzed.At the same time,according to whether they are accompanied by immune complex deposition,25 patients were divided into groups with immune complex deposition and those without immune complex deposition.The general information,clinical first-onset manifestations,laboratory examinations and prognosis between the two groups were carried out.comparative analysis.Furthermore,61 patients were divided into HD dependent and non-HD dependent groups according to whether the patients were HD dependent,and the general information,clinical first-onset manifestations,laboratory examinations and prognosis between the two groups were compared and analyzed.Results: 1.Among 61 patients,34 were males(55.74%)and 27 were females(44.26%).The ratio of male to female was 1.26:1.The age of the patients spanned from 17 to 85 years old.15 patients(24.59%)were 60 years old or less.46 patients(75.41%)were older than 60 years old.Among 61 patients,16 patients(26.23%)had symptoms of fatigue and anorexia,and 22 patients(36.07%)had fever symptoms;the clinical manifestations of kidney damage were followed by 26 patients(42.63%)with edema,oliguria,and urine.Pain,proteinuria occurred in 20 cases(32.79%),hematuria occurred in 8 cases(13.11%);lung damage was the most common extrarenal damage,5 of 61 patients(8.2%)had digestive system involvement,17 cases(26.23%)lung involvement,5 cases(8.20%)skin involvement,12 cases(19.67%)joint muscle involvement,and 1 case(1.64%)nervous system involvement.2.Among 61 patients,42 were p ANCA-positive patients,including 25 male patients and 17 female patients.The average age of p ANCA-positive patients was 59.79±14.29 years old.There were19 c ANCA-positive patients,including 9 male patients and 10 female patients,c ANCA-positive The average age of the patients was 60.79±16.85 years old.There was no statistical difference in the average age between the two groups.Compared with the c ANCA-positive group,the p ANCA-positive group had a higher incidence of pulmonary involvement(P=0.022),and there was no statistical difference in other clinical symptoms between the two groups.Compared with the p ANCA positive group,the c ANCA positive group had low Hb(P=0.009),low platelets(P<0.0001),high CRP(P=0.005),high PCT(P=0.0007),high ESR(P=0.032),total High protein(P=0.001),low albumin(P<0.0001),high AST(P<0.001),high Scr(P=0.010),low complement C3(P=0.0005),low complement C4(P<0.0001),Low serum Ig G(P=0.030),high serum Ig M(P<0.0001),low serum Ig A(P=0.036),high urine specific gravity(P<0.0001),high urine red blood cell(P=0.001),the difference is statistically significant Significance: There were no statistical differences in white blood cells,total bilirubin,ALT,LDH,creatine kinase,urea nitrogen,uric acid,glomerular filtration rate(e GFR),urine p H,24-hour urine protein,and urine white blood cells between the two groups.Comparing the difference in prognosis between the two groups,the incidence of HD dependence in the c ANCA positive group was high(P=0.044),but there was no statistical difference in the mortality rate within 1 year between the two groups.3.Among the 25 renal biopsy patients,16 were p ANCA positive and 9 were c ANCA positive.Comparing the pathological characteristics between the two groups of patients,compared with the p ANCA positive group,the proportion of cellular crescents in the c ANCA positive group was relatively low(P=0.003),while the proportion of fibrous crescents was relatively high(P=0.019),small arteries The high rate of fibrinoid necrosis(P=0.037)suggests that patients with positive c ANCA have a poor prognosis.In addition,14 cases of crescentic nephritis and 11 cases of non-crescentic nephritis were among the 25 patients undergoing renal biopsy.There was no statistical difference in the type of ANCA-positive antibody between the two groups of patients and whether it was crescentic nephritis.There was no statistical difference in gender and age between the two groups.Comparing the clinical symptoms of patients with crescentic nephritis group and non-crescentic nephritis group,there was no statistical difference in atypical symptoms,renal manifestations and extrarenal manifestations between the two groups.Compared with the non-crescent nephritis group,the crescent nephritis group had low white blood cells(P=0.003),low Hb(P=0.038),low platelets(P=0.037),high CRP(P=0.042),and high ESR(P=0.046),high LDH(P=0.045),high Scr(P=0.024),high urea nitrogen(P=0.028),low complement C3(P=0.038),low complement C4(P=0.029),serum Ig G Low(P=0.017),low serum Ig A(P=0.033),high uric acid(P<0.0001),low glomerular filtration rate(P=0.031),high 24-hour urine protein(P=0.040),urine red blood cells High(P=0.039),high urine white blood cells(P=0.013),the difference was statistically significant;PCT,total protein,albumin,total bilirubin,ALT,AST,creatine kinase,serum Ig M,urine There was no statistical difference in specific gravity and urine p H.Comparing the difference in prognosis between the two groups,the incidence of HD dependence in the crescent nephritis group was high(P=0.025),but there was no statistical difference in mortality within 1 year between the two groups.4.Among the 25 patients,5 cases were accompanied by immune complex deposition and 20 cases were not accompanied by immune complex deposition.There was no statistical difference in the type of ANCA-positive antibody and whether it was accompanied by immune complex deposition between the two groups.There was no statistical difference between the two groups of patients in terms of gender,average age,atypical symptoms,renal and extrarenal manifestations.Compared with the group without immune complex deposition,the group with immune complex deposition had high white blood cells(P=0.042),low Hb(P=0.049),high CRP(P=0.039),high ESR(P=0.037),muscle High acid kinase(P=0.022),high Scr(P=0.021),high urea nitrogen(P=0.026),high serum Ig G(P=0.015),high uric acid(P=0.027),low glomerular filtration rate(P=0.017),high urine red blood cell(P=0.037),the difference was statistically significant;platelets,PCT,total protein,albumin,ALT,AST,LDH,complement C3,complement C4,serum Ig A,serum Ig M between the two groups There were no statistical differences in urine specific gravity,urine p H,24-hour urine protein and urine white blood cells.Comparing the difference in prognosis between the two groups,the incidence of HD dependence in the group with immune complex deposition was high(P=0.015),but there was no statistical difference in mortality within 1 year between the two groups.5.61 patients with AASV have kidney damage,35 patients have not been separated from hemodialysis treatment(HD dependent group),26 patients have maintenance medication(non-HD dependent group),ANCA antibody type,gender and age in HD dependent and HD non-dependent groups There is no statistical difference.Compared with the non-HD dependent group,the HD dependent group had a higher incidence of edema,oliguria,and low back pain(P=0.033),and there was no statistical difference in other clinical symptoms between the two groups.Compared with the non-HD dependent group,the HD dependent group had low Hb(P<0.0001),high CRP(P=0.002),fast ESR(P=0.002),high Scr(P=0.01),and low complement C3(P= 0.001),low complement C4(P<0.0001),high serum Ig G(P=0.009),low serum Ig M(P=0.027),high serum Ig A(P=0.009),high uric acid(P=0.004),glomerulus Filtration rate is low(P=0.0001),urine red blood cell is high(P=0.020),the difference is statistically significant;between the two groups of white blood cells,platelets,PCT,total protein,albumin,total bilirubin,ALT,AST,There was no statistical difference in LDH,creatine kinase,urea nitrogen,urine specific gravity,urine p H,24-hour urine protein and urine white blood cells.6.The results of univariate logistic regression analysis showed ANCA type(P=0.004),baseline Scr(P=0.002),baseline e GFR(P=0.003),Hb(P=0.018),ESR(P=0.023),complement C3(P= 0.034)and crescentic nephritis(P=0.002)are associated with HD dependence in patients with AASVKI.Multivariate logistic regression analysis showed that ANCA type(P=0.043),baseline e GFR(P=0.039)and crescentic nephritis(P=0.041)were independently associated with HD dependence in AASVKI patients.Conclusion: The results of this study showed that the predominantly p ANCA-positive patients in AASVKI,p ANCA-positive and c ANCA-positive patients are significantly different,compared with p ANCA-positive patients,c ANCA-positive patients have poor baseline renal function,high incidence of HD dependence,and poor prognosis.There are also differences in different pathological types.Compared with patients with non-crescent body,patients with crescent body have poor baseline renal function,high incidence of HD dependence,and poor prognosis;compared with patients without immune complex deposition,they are accompanied by immune complex deposition Patients with poor baseline renal function,high incidence of HD dependence,and poor prognosis.Compared with non-HD dependent patients,HD dependent patients have a higher incidence of edema,oliguria and low back pain,poor baseline renal function,and poor prognosis.c ANCA,low-level baseline e GFR and crescentic nephritis are independent risk factors for HD dependence in patients with AASVKI.