Nephrology Dialysis Transplantation, Vol 13, Issue 7 1696-1701, Copyright © 1998 by Oxford University Press
K McLaughlin, P Jerimiah, J Fox, R Mactier, K Simpson and J Boulton-Jones
Background: Over the past 14 years, important advances
have been made in diagnosis and treatment of patients with pauci-immune
necrotizing glomerulonephritis (PINGN). The present study set out to
evaluate the impact of these advances on prognosis by comparing patient
survival during the period 1985-1995 with previously reported results for
such patients between 1975 and 1982. Method: A
retrospective analysis was carried out at two affiliated inner-city renal
units on all patients considered to have PINGN during the period 1985-1995.
Details of renal and extra-renal disease at presentation and during
follow-up, along with treatment regimes, were noted. Figures for renal and
patient survival were compared with those previously reported from one of
these units. Results: A total of 47 patients were
diagnosed over the period 1985-1995, with a median age of 57 years. The
overall patient survival (±standard error) at 1 and 5 years was
72.3 (±0.06) and 51.2% (±0.12) respectively, with
corresponding renal survival (alive and independent of renal replacement
therapy) at these times of 61.7 (±0.07) and 49.9%
(±0.09) respectively. We identified increased age at
presentation and advanced renal failure (requiring dialysis or serum
creatinine >300 &mgr;mol/l) as predictors of reduced patient and
renal survival. When comparing our results with those previously reported
(1975-1982), we found no improvement in prognosis for patients with PINGN
during the latter period. Conclusions: These results
suggest that the prognosis for patients with PINGN has not improved despite
diagnostic and therapeutic advances. Delay in diagnosis and treatment may
compromise the therapeutic potential in PINGN. Key
words: ANCA; pauci-immune necrotizing glomerulonephritis;
rapidly progressive glomerulonephritis
ORIGINAL ARTICLES
Has the prognosis for patients with pauci-immune necrotizing glomerulonephritis improved?
Renal Unit, Royal Infirmary and Renal Unit, Stobhill Hospital, Glasgow, UK; Corresponding author at: University Hospital, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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