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Pediatr Nephrol. 2019 Aug;34(8):1425-1433. doi: 10.1007/s00467-019-04228-4. Epub 2019 May 10.

Epidemiology and clinical features of childhood-onset anti-neutrophil cytoplasmic antibody-associated vasculitis: a clinicopathological analysis.

Author information

1
Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
2
Department of Pediatrics, Nara Medical University, Nara, Japan.
3
Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan.
4
Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
5
Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
6
Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan.
7
Department of Pediatrics, Graduate School of Medicine, Yokohama City University, 3-9 Fuku-ura, Kanazawa-ku, Yokohama, 236-0004, Japan. itoshu@yokohama-cu.ac.jp.

Abstract

BACKGROUND:

This study was performed to determine the clinical features and outcomes of childhood-onset anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), particularly microscopic polyangiitis (MPA).

METHODS:

A retrospective Japanese multicenter study was performed in patients diagnosed with AAV before 16 years of age.

RESULTS:

Of 49 patients with AAV, 36 were female. The diagnoses were as follows: MPA (n = 38, 78%), granulomatosis with polyangiitis (GPA; n = 9, 18%), eosinophilic granulomatosis with polyangiitis (EGPA; n = 1, 2%), and other (n = 1, 2%). The median age at onset was 10.7 years, and median time to diagnosis was 2.0 months. Twenty-seven (55%) patients were identified through a school urinary screening program. Initial symptoms included fever and fatigue (45%), and renal (71%), pulmonary (29%), ocular (20%), and mucocutaneous involvement (22%). Although 27 (55%) patients achieved remission and none had died at the last follow-up, at least one recurrence occurred in 13 (48%) patients after a median of 48 months and was more common in patients with GPA (P < 0.01). After a median follow-up of 43 months, seven (14%) patients (all with MPA) progressed to end-stage renal disease (ESRD).

CONCLUSIONS:

Childhood-onset AAV has an estimated prevalence of 3.41-4.28 per million children and is characterized by female predominance and high frequency of detection in school urinary screening programs. More than 10% of patients with childhood-onset AAV still progress to ESRD without achieving remission. Histological chronicity is a factor associated with ESRD.

KEYWORDS:

Anti-neutrophil cytoplasmic antibody–associated vasculitis; Epidemiology; Microscopic polyangiitis; Pediatric patient; Vasculitis

PMID:
31076873
DOI:
10.1007/s00467-019-04228-4

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