PMID- 29287586 OWN - NLM STAT- MEDLINE DCOM- 20180827 LR - 20181113 IS - 1471-2369 (Electronic) IS - 1471-2369 (Linking) VI - 18 IP - 1 DP - 2017 Dec 29 TI - The impact of intravenous methylprednisolone pulses on renal survival in anti-neutrophil cytoplasmic antibody associated vasculitis with severe renal injury patients: a retrospective study. PG - 381 LID - 10.1186/s12882-017-0782-4 [doi] LID - 381 AB - BACKGROUND: High-dose methylprednisolone pulses were one of the main treatments for anti-neutrophil cytoplasmic autoantibody (ANCA) associated vasculitides (AAV) but had obvious side effects. We aimed to know the impact on renal survival and identify the prognostic factors of this treatment in Chinese AAV patients with severe renal involvement. METHODS: One hundred and eleven AAV patients with an estimated glomerular filtration rate (eGFR) of 10ml/min/1.73 m(2) or less at admission were included. The MP group (n = 57) received intravenous methylprednisolone 500 mg/d for 3 days, while the control group (n = 54) had not. The outcomes and adverse events between two groups were compared. Besides, predictors for dialysis independence and good response of intravenous methylprednisolone were analyzed using Cox regression analysis and ROC curves respectively. RESULTS: Their median duration of follow-up was 31 (range 3 to 134) months. Eleven patients in MP group and 20 patients in control group were died (P = 0.056). Twenty-one patients (36.8%) in MP group and 29 patients (53.7%) in control group were on maintaining dialysis (P = 0.088). Twenty-one patients in MP group remained dialysis independent, more than those in control group (4 patients, P <0.01). Urine protein creatinine ratio (hazard ratio 1.730, 95% confidence interval 1.029 to 2.909, P = 0.039) and the treatment of intravenous methylprednisolone pulses (hazard ratio 0.362, 95% confidence interval 0.190 to 0.690, P = 0.002) were the independent risk factors for dialysis independence. Those patients with serum creatinine>/=855mumol/L and urine protein >/=3.7g/24h at admission may have worse responses to intravenous methylprednisolone pulses (sensibility 56.7%, specificity 85.0%, PPV 100.0% and NPV57.1%). CONCLUSIONS: Intravenous methylprednisolone pulses could improve the long-term outcome in term of dialysis independence and tend to decrease mortality for Chinese AAV patients with severe renal involvement. FAU - Ma, Yanhong AU - Ma Y AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Han, Fei AU - Han F AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. hanf8876@zju.edu.cn. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. hanf8876@zju.edu.cn. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. hanf8876@zju.edu.cn. FAU - Chen, Liangliang AU - Chen L AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Wang, Hongya AU - Wang H AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Han, Haidongqing AU - Han H AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Yu, Binfeng AU - Yu B AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Xu, Ying AU - Xu Y AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. FAU - Chen, Jianghua AU - Chen J AD - Kidney Disease Center, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China. AD - Key Laboratory of Kidney Disease Prevention and Control Technology, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China. AD - Third Grade Laboratory under the National State Administration of Traditional Chinese Medicine, Hangzhou, People's Republic of China. LA - eng GR - 2013KYA072/the Medical Research Funding of Zhejiang Province, China (2013KYA072) to Fei Han/International GR - 81570605/National Natural Science Foundation of China/International GR - LY15H050004/Natural Science Foundation of Zhejiang Province/International PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20171229 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Anti-Inflammatory Agents) RN - 0 (Antibodies, Antineutrophil Cytoplasmic) RN - X4W7ZR7023 (Methylprednisolone) SB - IM MH - Acute Kidney Injury/*blood/*drug therapy/epidemiology MH - Adult MH - Aged MH - Anti-Inflammatory Agents/administration & dosage MH - Antibodies, Antineutrophil Cytoplasmic/*blood MH - Female MH - Humans MH - Injections, Intravenous MH - Male MH - Methylprednisolone/*administration & dosage MH - Middle Aged MH - Retrospective Studies MH - Severity of Illness Index MH - Vasculitis/*blood/*drug therapy/epidemiology PMC - PMC5747949 OTO - NOTNLM OT - Anti-neutrophil cytoplasmic autoantibody OT - Kidney OT - Methylprednisolone OT - Outcome OT - Vasculitis COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study protocols conformed to the provisions of the Declaration of Helsinki and were approved by the Ethic Committee of the First Affiliated Hospital of Medical School of Zhejiang University (reference number: 201721). Due to the retrospective nature of the study, informed consents were obtained from participants verbally by phone contact (the participants' next of kin assisted in communication in cases the participants could not communicate with the researchers directly). CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. EDAT- 2017/12/31 06:00 MHDA- 2018/08/28 06:00 PMCR- 2017/12/29 CRDT- 2017/12/31 06:00 PHST- 2017/03/16 00:00 [received] PHST- 2017/12/07 00:00 [accepted] PHST- 2017/12/31 06:00 [entrez] PHST- 2017/12/31 06:00 [pubmed] PHST- 2018/08/28 06:00 [medline] PHST- 2017/12/29 00:00 [pmc-release] AID - 10.1186/s12882-017-0782-4 [pii] AID - 782 [pii] AID - 10.1186/s12882-017-0782-4 [doi] PST - epublish SO - BMC Nephrol. 2017 Dec 29;18(1):381. doi: 10.1186/s12882-017-0782-4.