Risk factors for renal outcomes in children with antineutrophil cytoplasmic antibody-associated vasculitis: a nationwide retrospective study in China
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Published:2023-10-19
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ISSN:1708-8569
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Container-title:World Journal of Pediatrics
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language:en
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Short-container-title:World J Pediatr
Author:
Tan Li-Wen, Wan Jun-Li, Zhu Chun-Hua, Xu Hong, Xia Zheng-Kun, Chen Li-Zhi, Wu Xiao-Chuan, Wang Fang, Liu Xiao-Rong, Zhao Cheng-Guang, Li Xiao-Zhong, Mao Jian-Hua, Wang Xiao-Wen, Huang Wen-Yan, Li Yu-Hong, Zhang Jian-Jiang, Feng Shi-Pin, Yang Jun, Liu Jiao-Jiao, Gao Chun-Lin, Rong Li-Ping, Shuai Lan-Jun, Xu Ke, Zhang He-Jia, Li Qiu, Zhang Ai-Hua, Wang MoORCID
Abstract
Abstract
Background
Pediatric antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a life-threatening systemic vasculitis featured by liability to renal involvement. However, there are few studies on the risk factors and predictive models for renal outcomes of AAV in children.
Methods
Data from 179 AAV children in multiple centers between January 2012 and March 2020 were collected retrospectively. The risk factors and predictive model of end-stage renal disease (ESRD) in AAV were explored.
Results
Renal involvement was the most typical manifestation (95.5%), and the crescent was the predominant pathological lesion (84.9%). The estimated glomerular filtration rate (eGFR) was evaluated in 114 patients, of whom 59.6% developed ESRD, and the median time to ESRD was 3.20 months. The eGFR [P = 0.006, odds ratio (OR) = 0.955, 95% confidence interval (CI) = 0.924–0.987] and the percentages of global glomerulosclerosis (pGGS; P = 0.018, OR = 1.060, 95% CI = 1.010–1.112) were independent risk factors for ESRD of renal biopsy. Based on the pGGS and eGFR at renal biopsy, we developed three risk grades of ESRD and one predictive model. The Kaplan‒Meier curve indicated that renal outcomes were significantly different in different risk grades (P < 0.001). Compared with serum creatinine at baseline, the predictive model had higher accuracy (0.86 versus 0.58, P < 0.001) and a lower coefficient of variation (0.07 versus 0.92) in external validation.
Conclusions
Renal involvement is the most common manifestation of pediatric AAV in China, of which more than half deteriorates into ESRD. The predictive model based on eGFR at renal biopsy and the pGGS may be stable and accurate in speculating the risk of ESRD in AAV children.
Funder
National Key R&D Program of China Key Technologies Research and Development Program of Anhui Province Center for Depression Research and Clinical Care, University of Texas Southwestern Medical Center
Publisher
Springer Science and Business Media LLC
Subject
Pediatrics, Perinatology and Child Health
Reference25 articles.
1. Calatroni M, Consonni F, Allinovi M, Bettiol A, Jawa N, Fiasella S, et al. Prognostic factors and long-term outcome with ANCA-associated kidney vasculitis in childhood. Clin J Am Soc Nephrol. 2021;16:1043–51. 2. Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suárez LF. Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant. 2015;30(Suppl 1):i14–22. 3. Jariwala M, Laxer RM. Childhood GPA, EGPA, and MPA. Clin Immunol. 2020;211:108325. 4. de Joode AA, Sanders JS, Stegeman CA. Renal survival in proteinase 3 and myeloperoxidase ANCA-associated systemic vasculitis. Clin J Am Soc Nephrol. 2013;8:1709–17. 5. Khalighi MA, Wang S, Henriksen KJ, Bock M, Keswani M, Chang A, et al. Pauci-immune glomerulonephritis in children: a clinicopathologic study of 21 patients. Pediatr Nephrol. 2015;30:953–9.
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