OBJECTIVE Renal involvement in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis is associated with significant morbidity and higher mortality rates. This study examined clinical manifestations associated with renal involvement in ANCA-associated vasculitis within a large, international cross-sectional cohort. METHODS Univariate and multivariate analyses were performed to identify clinical factors associated with renal disease, which was defined as i) a serum-creatinine >30% above normal and a fall in creatinine-clearance >25%; or ii) haematuria attributable to active vasculitis. RESULTS The study cohort include 1230 patients from 31 countries; 723 (58.8%) presented with renal involvement: microscopic polyangiitis (82.2%), granulomatosis with polyangiitis (58.6%), and eosinophilic granulomatosis with polyangiitis (26.4%). The following clinical and laboratory factors were more common among patients with renal disease: age (OR 1.01, 95% CI 1.01-1.02), fever (OR 1.97, 95% CI 1.35-2.88), fatigue (OR 1.55, 95% CI 1.14-2.10), weight loss (OR 1.62, 95% CI 1.23-2.12), polyarthritis (OR 1.39, 95% CI 1.02-1.89), petechiae/purpura (OR 1.47, 95% CI 1.06-2.05), pulmonary haemorrhage (OR 5.23, 95% CI 1.39-19.63), gastrointestinal symptoms (OR 2.19, 95% CI 1.34-3.58), seizures (OR 3.42, 95% CI 1.26-9.30), lower serum albumin (OR 2.42, 95% CI 1.64-3.57), higher CRP (OR 2.06, 95% CI 1.04-4.06), low serum C3 at baseline (OR 3.86, 95% CI 1.30-11.53), myeloperoxidase- (OR 7.97, 95% CI 2.74-23.20) and proteinase 3-ANCA (OR 3.40, 95% CI 1.22-9.50). The following clinical factors were less common among patients with renal disease: mononeuritis multiplex (OR 0.63, 95% CI 0.41-0.98), proptosis/exophthalmos (OR 0.19, 95% CI 0.06-0.59), nasal polyps (OR 0.32, 95% CI 0.19-0.55), septal defect/perforation (OR 0.29, 95% CI 0.14-0.60), respiratory distress/pulmonary fibrosis/asthma (OR 0.08, 95% CI 0.04-0.19), and wheeze/obstructive airway disease (OR 0.29, 95% CI 0.16-0.52). CONCLUSION In this large international study, several clinical and laboratory factors were identified as associated with renal involvement in ANCA-associated vasculitis.

中文翻译：

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肾参与ANCA相关血管炎的临床关联。

目的肾脏参与抗中性粒细胞胞浆抗体（ANCA）相关的血管炎与发病率高和死亡率高有关。这项研究在一个大型的国际性横断队列研究中检验了与肾脏参与ANCA相关血管炎相关的临床表现。方法采用单因素和多因素分析来确定与肾脏疾病相关的临床因素，定义为：i）血清肌酐比正常水平高30％，肌酐清除率下降> 25％；或ii）归因于活动性血管炎的血尿。结果该研究队列包括来自31个国家的1230名患者；723例（58.8％）表现为肾脏受累：镜下性多血管炎（82.2％），肉芽肿伴多血管炎（58.6％）和嗜酸性肉芽肿伴多血管炎（26.4％）。以下临床和实验室因素在肾病患者中更为常见：年龄（OR 1.01，95％CI 1.01-1.02），发烧（OR 1.97，95％CI 1.35-2.88），疲劳（OR 1.55，95％CI 1.14） -2.10），体重减轻（OR 1.62、95％CI 1.23-2.12），多关节炎（OR 1.39、95％CI 1.02-1.89），瘀斑/紫癜（OR 1.47、95％CI 1.06-2.05），肺出血（OR 5.23，95％CI 1.39-19.63），胃肠道症状（OR 2.19，95％CI 1.34-3.58），癫痫发作（OR 3.42，95％CI 1.26-9.30），血清白蛋白降低（OR 2.42，95％CI 1.64-3.57） ），较高的CRP（OR 2.06、95％CI 1.04-4.06），基线血清C3低（OR 3.86、95％CI 1.30-11.53），髓过氧化物酶-（OR 7.97、95％CI 2.74-23.20）和蛋白酶3- ANCA（或3.40，95％CI 1.22-9.50）。以下临床因素在肾病患者中较少见：多发性单一神经炎（OR 0.63，95％CI 0.41-0.98），眼球突出症/眼球突出症（OR 0.19，95％CI 0.06-0.59），鼻息肉（OR 0.32，95％CI 0.19-0.55），间隔缺损/穿孔（OR 0.29，95％CI 0.14-0.60），呼吸窘迫/肺纤维化/哮喘（OR 0.08，95％CI 0.04-0.19）和喘息/阻塞性气道疾病（OR 0.29，95％CI 0.16-0.52）。结论在这项大型的国际研究中，一些临床和实验室因素被确定与ANCA相关血管炎的肾脏受累有关。