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学科主题: 临床医学
题名:
Clinicopathologic Characteristics and Outcomes of Renal Thrombotic Microangiopathy in Anti-Neutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis
作者: Chen, Su-Fang1,2,3; Wang, Huan1,2,3; Huang, Yi-Min1,2,3; Li, Zhi-Ying1,2,3; Wang, Su-Xia1,2,3; Yu, Feng1,2,3; Zhao, Ming-Hui1,2,3,4; Chen, Min1,2,3
刊名: CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
发表日期: 2015-05-01
DOI: 10.2215/CJN.07910814
卷: 10, 期:5, 页:750-758
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Urology & Nephrology
研究领域[WOS]: Urology & Nephrology
关键词[WOS]: ANCA-ASSOCIATED VASCULITIS ; HEMOLYTIC-UREMIC SYNDROME ; ANTIBODY-ASSOCIATED VASCULITIS ; SMALL-VESSEL VASCULITIS ; MICROSCOPIC POLYANGIITIS ; CRESCENTIC GLOMERULONEPHRITIS ; THROMBOCYTOPENIC PURPURA ; COMPLEMENT ACTIVATION ; TREATMENT RESISTANCE ; DISEASE
英文摘要:

Background and objectives Thrombotic microangiopathy (TMA) in ANCA-associated vasculitis (AAV) has been mainly reported in isolated case reports. The aim of this study was to analyze clinical and pathologic characteristics and prognosis of patients with renal TMA in ANCA-associated GN in a large cohort of Chinese patients.

Design, setting, participants, & measurements Clinical and renal histopathologic data of 220 patients with biopsy-proven ANCA-associated GN from 1996 to 2013 were retrospectively analyzed. Patients were followed up for a median period of 32 (interquartile range [IQR], 12-65) months, and outcomes of patients were analyzed.

Results Among the 220 patients with ANCA-associated GN, 30 were identified having concomitant renal TMA by pathologic evaluation. Compared with the non-TMA group, patients with renal TMA presented with more severe renal injury, as evidenced clinically by a higher level of serum creatinine at diagnosis (5.0 [IQR, 3.5-9.0] versus 3.2 [IQR, 1.7-6.8] mg/dl; P=0.02) and pathologically by a higher percentage of cellular crescents (15.0% [IQR, 6.9%-34.9%] versus 6.9% [IQR, 0%-21.1%]; P=0.04) and more severe interstitial infiltration (2 [IQR, 2-2] versus 2 [IQR, 1-2]; P=0.03) in renal biopsies. Furthermore, multivariate analysis showed that renal TMA was independently associated with mortality of patients with AAV after adjusting for age, sex, initial serum creatinine, tubular atrophy, and interstitial fibrosis (hazard ratio, 1.92; 95% confidence interval, 1.08 to 3.41; P=0.03) or for age, sex, the histopathologic classification scheme proposed by Berden et al. (I Am Soc NePhrol 21: 1628-1636, 2010), tubular atrophy, and interstitial fibrosis (hazard ratio, 1.95; 95% confidence interval, 1.07 to 3.55; P=0.03).

Conclusions Renal TMA in ANCA-associated GN is not rare and presents with more severe renal injury. Renal TMA is independently associated with all-cause mortality in patients with AAV.

语种: 英语
所属项目编号: 2012CB517700 ; 81425008 ; 81370829 ; 81321064 ; 8140040085
项目资助者: Chinese 973 project ; National Natural Science Fund
WOS记录号: WOS:000354144900006
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/62164
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.Peking Univ, Dept Med, Hosp 1, Div Renal, Beijing 100034, Peoples R China
2.Minist Hlth China, Key Lab Renal Dis, Beijing, Peoples R China
3.Peking Univ, Minist Educ, Key Lab Chron Kidney Dis Prevent & Treatment, Beijing 100034, Peoples R China
4.Peking Tsinghua Ctr Life Sci, Beijing, Peoples R China

Recommended Citation:
Chen, Su-Fang,Wang, Huan,Huang, Yi-Min,et al. Clinicopathologic Characteristics and Outcomes of Renal Thrombotic Microangiopathy in Anti-Neutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis[J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY,2015,10(5):750-758.
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