Analysis Of Prognosis And Risk Factors In ANCA-Associated Vasculitis Kidney Injury

Objective: To explore the prognosis and independent risk factors of ANCAassociated vasculitis kidney injury(AASVKI),and to provide guidance for the clinical work of this disease.Methods: A retrospective analysis was performed on 104 newly diagnosed patients with AASVKI in the First Affiliated Hospital of Guangxi Medical University from 2009 to 2020.The general information,clinical manifestations,laboratory examination,renal pathology examination,and treatment methods of the patients at the time of diagnosis were collected.Patients’ survival and renal survival were regularly followed up.Patient death was the end of survival analysis,and patient entry into ESRD was the end point of renal survival analysis.The clinicopathological and prognosis data of the patients were statistically analyzed.Univariate and multivariate Cox regression analysis was used to analyze the clinicopathological and prognostic data of the patients to determine the independent factors affecting the survival and renal survival of the patients.Results:(1)A total of 104 patients were enrolled,including 44 males(42%)and 60 females(58%),the median age was 58(46,65)years.Follow-up Period ranged from 9 to 140 months,the median follow-up time was 41(27,68)months,during which 56 patients(54%)developed ESRD and 21 patients(20%)died.(2)Renal survival prognosis analysis: Urea nitrogen(P=0.022,HR=1.038),mesangial hyperplasia(P=0.041,HR=1.441),renal tubule atrophy(P=0.011,HR=1.837),renal Ig M deposition(P=0.004,HR=2.681)were independent risk factors for poor renal survival in patients with AASVKI.e GFR(P=0.001,HR=0.919)and normal glomerular proportion(P=0.017,HR=0.982)were independent protective factors for good renal survival in patients with AASVKI.In patients with AASVKI,the higher of urea nitrogen level,the lower of EGFR,the lower of normal glomerular proportion,the heavier of mesangial hyperplasia,the more severe of renal tubule atrophy,and the renal Ig M deposition,the worse the prognosisof renal survival.(3)Survival analysis: mesangial hyperplasia(P=0.009,HR=2.128)was an independent risk factor for poor survival in patients with AASVKI.The heavier of mesangial hyperplasia in patients with AASVKI,the worse the survival prognosis.Conclusion:(1)Patients with ANCA-associated vasculitis and renal damage have a poor prognosis.(2)Urea nitrogen,mesangial hyperplasia,renal tubule atrophy,and renal Ig M deposition can be independent risk factors for poor renal survival prognosis in patients with AASVKI,and EGFR and normal glomerular proportion can be independent protective factors for good renal survival prognosis in patients with AASVKI.(3)Mesangial hyperplasia can be an independent risk factor for poor survival in patients with AASVKI.