IMPACT OF KIDNEY BIOPSY IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)-ASSOCIATED VASCULITIS

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IMPACT OF KIDNEY BIOPSY IN PATIENTS WITH ANTINEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)-ASSOCIATED VASCULITIS

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Co-author 1

Makoto Harada tokomadaraha724@gmail.com Shinshu University Department of Nephrology Matsumoto Japan *

Co-author 2

Akinori Yamaguchi ymgc@shinshu-u.ac.jp Shinshu University Department of Nephrology Matsumoto Japan -

Co-author 3

Koji Hashimoto khashi@shinshu-u.ac.jp Shinshu University Department of Nephrology Matsumoto Japan -

Co-author 4

Yuji Kamijo yujibeat@shinshu-u.ac.jp Shinshu University Department of Nephrology Matsumoto Japan -

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Introduction

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) often leads to severe kidney injury and end-stage kidney disease (ESKD) despite treatment. Kidney biopsy is used to assess the severity of kidney lesions caused by AAV. This study aimed to investigate the association of kidney biopsy with intensive immunosuppressive therapy and clinical outcomes in patients with AAV with kidney impairment.

Methods

In this retrospective study, propensity score overlap weighting was applied to compare intensive immunosuppressive therapy and clinical outcomes (ESKD, death, combined ESKD and death, and infectious complications) between patients with AAV who underwent kidney biopsy and those who did not.

Results

Out of 74 patients with AAV, 38 underwent kidney biopsy. Overlap weight analysis revealed that kidney biopsy was significantly associated with intensive immunosuppressive therapy (risk difference [RD], 28.9%; 95% confidence interval [CI], 0.017 to 0.562). Kidney biopsy was not associated with combined ESKD and death (RD, -0.2%; 95% CI, -0.302 to 0.298), death (RD, -3.8%; 95% CI, -0.264 to 0.189), ESKD (RD, -7.3%; 95% CI, -0.353 to 0.207), and infectious complications (RD, -25.9%; 95% CI, -0.537 to 0.020). The most common reasons for not performing kidney biopsy were older age, reduced cognitive abilities, and reduced activities of daily living following the use of anticoagulants and/or antiplatelet agents.

Conclusion

Kidney biopsy for the assessment of AAV severity contributes to intensive immunosuppression; however, additional clinical benefits to patients with AAV were not detected. It is important to carefully consider which older patients with AAV and multiple comorbidities require biopsy and intensive immunosuppressive therapy.

Kewords