Low levels of hemoglobin associate with critical illness and predict disease course in patients with ANCA-associated renal vasculitis

Baier, Eva; Tampe, Désirée; Hakroush, Samy; Tampe, Björn

doi:10.1038/s41598-022-23313-7

Cited by 6 publications

(5 citation statements)

References 52 publications

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“…Severe anemia that was not consistent with renal failure and hemoptysis indicated that the mechanism of anemia in patients with AAV was much more complex. Low levels of hemoglobin had a negative effect on short-term prognosis in AAV patients [21]. Previous studies had suggested that the pathogenesis of anemia in AAV with renal injury differed from that of other immune-related diseases, and the factors that might contribute to the development of anemia in AAV patients have not been fully clarified yet.…”

Section: Discussionmentioning

confidence: 97%

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

Yu,

Wang,

et al. 2024

JPM

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Background: Previous studies indicated common thyroid dysfunction in various kidney diseases. This study aimed to investigate the thyroid function in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal injury. Methods: Briefly, 174 patients diagnosed as having AAV with renal injury and without previous thyroid disease history were included in the retrospective and prospective study. The clinical parameters were collected and compared between different groups. Results: Of the patients included, 24 exhibited normal thyroid function, while 150 had thyroid dysfunction, including 55 (36.67%) with hypothyroidism. Those AAV patients with thyroid dysfunction showed different clinical parameters from those with normal thyroid function. The patients were followed up for a median of 68.6 (64.3; 72.8) months. Those with thyroid dysfunction were more prone to progressing to dialysis dependence compared to the group with normal thyroid function. Logistic regression analysis showed advanced age and decreased albumin as independent risk factors for thyroid dysfunction in patients with AAV. Survival analysis and multivariate Cox regression analysis showed that thyroid dysfunction was a risk factor for AAV patients with renal injury to progress to the endpoint of dialysis dependence. Conclusion: Thyroid dysfunction, predominantly hypothyroidism, was commonly complicated in AAV patients with renal injury. AAV patients with thyroid dysfunction were presented with different clinical parameters and more prone to progressing to dialysis dependence compared to those with normal thyroid function.

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Section: Discussionmentioning

confidence: 97%

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

Yu,

Wang,

et al. 2024

JPM

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“…We here directly compare the scoring system with retrospective data about PLEX treatment in our own clinical practice and according to current recommendations in patients presenting with a serum creatinine levels above 5.7 mg/dL (500 μmol/L) and/or requirement of KRT in a cohort of 53 AAV patients with RPGN confirmed by kidney biopsy, detailed information about critical illness in this patient cohort has recently been described ( 14 – 16 ).…”

Section: Methodsmentioning

confidence: 99%

Relevance of histopathological findings for predictive scoring of short-term treatment response to plasma exchange in severe ANCA-associated renal vasculitides

Hakroush,

Korsten,

Ströbel

et al. 2024

Front. Immunol.

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IntroductionRapidly progressive glomerulonephritis (RPGN) is characterized by a rapid loss of kidney function, affecting both renal and overall patient survival. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis affecting multiple organ systems including the kidney, and among most frequent causes of RPGN. We here aimed to validate a recently described scoring system for short-term treatment response to therapeutic plasma exchange (PLEX) in a well-characterized and independent cohort of severe renal AAV presenting with RPGN. Furthermore, we compared this scoring with established classification systems in renal AAV including histopathological findings.MethodsWe here directly compare the scoring system with retrospective data about PLEX treatment in our own clinical practice and according to current recommendations in a cohort of 53 patients with severe AAV presenting with RPGN confirmed by kidney biopsy.ResultsWe here confirm that PLEX scoring is capable to identify patients at risk for short-term poor outcome in severe AAV presenting with RPGN (p<0.0001). Furthermore, multiple stepwise regression analysis revealed that the PLEX score with renal biopsy performed best to predict poor outcome in this patient population (p<0.0001).ConclusionOur observations underscore the relevance of performing a kidney biopsy in this patient population that is often challenged in the setting of intensive care treatment, requirement of KRT with need for anticoagulation and bleeding risk. Therefore, validation of our observations and this recent scoring system for treatment response to PLEX in independent cohorts would be of great clinical relevance in the treatment of patients with severe AAV presenting with RPGN.

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“…The Birmingham Vasculitis Activity Score (BVAS) and the Simplified Acute Physiology Score II (SAPS II) were calculated as previously described [43,44]. The state of critical illness (CI) was defined as recently described [42,45]. Laboratory data assessment encompassed whole blood cell counts (WBC) including hemoglobin levels; platelet and leukocyte counts; and serum levels of inflammatory markers, such as C-reactive protein (CRP), ferritin, haptoglobin, procalcitonin (PCT) and albumin; serum creatinine and blood urea nitrogen (BUN) levels at admission; iron; lactate dehydrogenase (LDH); aspartate amino transferase (AST); alanine amino transferase (ALT); and alkaline phosphatase (AP).…”

Section: Study Population and Data Assessmentmentioning

confidence: 99%

Serum Uric Acid Associates with Systemic Complement C3 Activation in Severe ANCA-Associated Renal Vasculitides

Baier,

Kluge,

Hakroush

et al. 2024

IJMS

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Involvement of the complement system is key to the pathogenesis of antineutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis, but immunometabolic implications, especially on serum uric acid (UA) levels, still need to be elucidated. A total of 34 patients with biopsy-proven ANCA-associated renal vasculitis between 2015 and 2020 were retrospectively enrolled. Serum UA levels were correlated with clinical and histopathological characteristics, separated for critically ill (CI, n = 19), myeloperoxidase (MPO)-ANCA (n = 21) and proteinase 3 (PR3)-ANCA (n = 13) subgroups. We here identified inverse correlations of serum UA levels and complement C3 levels in the total cohort (p = 0.005) and the CI subgroup (p < 0.001). Intrarenal complement C4d deposition in venules correlated with serum UA levels in the total cohort (p = 0.007) and in the CI subgroup (p = 0.016). Significant associations of serum UA levels and tubulitis in areas of scarred cortex (t-IFTA) were identified in the total cohort (p = 0.008), and both subgroups of CI (p = 0.034) and MPO-ANCA (p = 0.029). In PR3-ANCA, interstitial fibrosis (ci) was observed as the strongest association with serum UA levels (p = 0.022). Our observations broaden our current understanding of contributory metabolic factors that influence the initial disease course in ANCA-associated renal vasculitis.

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Low levels of hemoglobin associate with critical illness and predict disease course in patients with ANCA-associated renal vasculitis

Cited by 6 publications

References 52 publications

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury

Relevance of histopathological findings for predictive scoring of short-term treatment response to plasma exchange in severe ANCA-associated renal vasculitides

Serum Uric Acid Associates with Systemic Complement C3 Activation in Severe ANCA-Associated Renal Vasculitides

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