HAS THE PROGNOSIS FOR PATIENTS WITH PAUCI-IMMUNE NECROTIZING GLOMERULONEPHRITIS IMPROVED

Background, Over the past 14 years, important advances have been made in diagnosis and treatment of patients with pauci-immune necrotizing g lomerulonephritis (PINGN). The present study set out to evaluate the i mpact of these advances on prognosis by comparing patient survival dur ing the period 1985-1995 with previously reported results for such pat ients between 1975 and 1982. Method. A retrospective analysis was carr ied out at two affiliated inner-city renal units on all patients consi dered to have PINGN during the period 1985-1995. Details of renal and extra-renal disease at presentation and during follow-up, along with t reatment regimes, were noted. Figures for renal and patient survival w ere compared with those previously reported from one of these units. R esults. A total of 47 patients were diagnosed over the period 1985-199 5, with a median age of 57 years. The overall patient survival (+/-sta ndard error) at 1 and 5 years was 72.3 (+/-0.06) and 51.2% (+/-0.12) r espectively, with corresponding renal survival (alive and independent of renal replacement therapy) at: these times of 61.7 (+/- 0.07) and 4 9.9% (+/- 0.09) respectively. We identified increased age at presentat ion and advanced renal failure (requiring dialysis or serum creatinine >300 mu mol/l) as predictors of reduced patient and renal survival. W hen comparing our results with those previously reported (1975-1982), we found no improvement in prognosis for patients with PINGN during th e latter period. Conclusions. These results suggest that the prognosis for patients with PINGN has not improved despite diagnostic and thera peutic advances. Delay in diagnosis and treatment may compromise the t herapeutic potential in PINGN.