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Clinical Research
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Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges

Dorian Nezam, Raphaël Porcher, François Grolleau, Pauline Morel, Dimitri Titeca-Beauport, Stanislas Faguer, Alexandre Karras, Justine Solignac, Noémie Jourde-Chiche, François Maurier, Hamza Sakhi, Khalil El Karoui, Rafik Mesbah, Pierre Louis Carron, Vincent Audard, Didier Ducloux, Romain Paule, Jean-François Augusto, Julien Aniort, Aurélien Tiple, Cédric Rafat, Séverine Beaudreuil, Xavier Puéchal, Pierre Gobert, Ziad Massy, Catherine Hanrotel, Stéphane Bally, Nihal Martis, Cécile-Audrey Durel, Geoffroy Desbuissons, Pascal Godmer, Aurélie Hummel, François Perrin, Antoine Néel, Claire De Moreuil, Tiphaine Goulenok, Dominique Guerrot, Steven Grange, Aurélie Foucher, Alban Deroux, Carole Cordonnier, Céline Guilbeau-Frugier, Anne Modesto-Segonds, Dominique Nochy, Laurent Daniel, Anissa Moktefi, Marion Rabant, Loïc Guillevin, Alexis Régent, Benjamin Terrier and on behalf of the French Vasculitis Study Group*
JASN March 2022, 33 (3) 628-637; DOI: https://doi.org/10.1681/ASN.2021060771
Dorian Nezam
1Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
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Raphaël Porcher
2Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
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  • ORCID record for Raphaël Porcher
François Grolleau
2Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
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Pauline Morel
3Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France
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Dimitri Titeca-Beauport
4Service de Néphrologie, CHU Amiens Picardie, Amiens, France
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  • ORCID record for Dimitri Titeca-Beauport
Stanislas Faguer
5Département de Néphrologie et Transplantation d’organes, Hôpital Rangueil, Toulouse, France
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Alexandre Karras
6Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
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Justine Solignac
7Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
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Noémie Jourde-Chiche
7Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
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François Maurier
8Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France
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Hamza Sakhi
9Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France
10Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
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Khalil El Karoui
9Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France
10Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
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Rafik Mesbah
11Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France
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Pierre Louis Carron
12Service de Néphrologie, Hôpital Nord, CHU Grenoble, Grenoble, France
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Vincent Audard
9Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France
10Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
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Didier Ducloux
13Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France
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Romain Paule
14Service de Médecine Interne, Hôpital Foch, Suresnes, France
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Jean-François Augusto
15Service de Néphrologie, Dialyse, Transplantation, CHU, CHU Angers, Angers, France
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Julien Aniort
16Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France
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Aurélien Tiple
17Service de Néphrologie, CHU Jacques Lacarin, Vichy, France
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Cédric Rafat
18Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France
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Séverine Beaudreuil
19Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France
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Xavier Puéchal
20Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Pierre Gobert
21Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France
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Ziad Massy
22Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France
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Catherine Hanrotel
23Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France
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Stéphane Bally
24Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France
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Nihal Martis
25Service de Médecine Interne, CHU Nice, France
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Cécile-Audrey Durel
26Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France
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Geoffroy Desbuissons
27Service de Néphrologie, Hôpitaux Privés de l’ouest Parisien, Trappes, France
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Pascal Godmer
28Service de Médecine Interne, CHBA site de Vannes, Vannes, France
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Aurélie Hummel
29Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France
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François Perrin
30Service de Médecine Interne, CHU de Saint-Nazaire, France
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Antoine Néel
31Service de Médecine Interne, CHU de Nantes, France
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Claire De Moreuil
32Service de Médecine Interne, CHRU de Brest, France
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Tiphaine Goulenok
33Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France
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Dominique Guerrot
1Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
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Steven Grange
34Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France
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Aurélie Foucher
35Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France
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Alban Deroux
36Service de Médecine Interne, CHU de Grenoble, France
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Carole Cordonnier
37Service d’anatomie et de cytologie pathologiques, Hôpital Nord, CHU d’Amiens, France
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Céline Guilbeau-Frugier
38Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
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Anne Modesto-Segonds
38Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
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Dominique Nochy
39Service d’Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France
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Laurent Daniel
40Service d’Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France
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Anissa Moktefi
41Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France
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Marion Rabant
42Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
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Loïc Guillevin
20Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Alexis Régent
20Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Benjamin Terrier
20Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Significance Statement

Findings of the international prospective multicenter PEXIVAS trial challenge the role of PLEX in AAV. We conducted a retrospective study of 425 patients: 188 with AAV and renal failure treated with PLEX and 237 not treated. A score to identify patients who would benefit from PLEX was developed. With kidney biopsy data, scores more than seven achieved sensitivity and specificity of 83.1% and 96.0%, respectively, for recommending PLEX. The average effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. Patients in the PLEX-recommended group had microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score. These findings, which require independent validation, could provide guidance in selecting patients with AAV who will benefit from PLEX.

Abstract

Background Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX.

Methods We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12).

Results No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (−15.9%; 95% CI, −29.4 to −2.5) compared with the PLEX not recommended group (−4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%.

Conclusions PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.

  • plasma exchange
  • anti-neutrophil cytoplasmic antibody-associated vasculitis
  • kidney biopsy
  • acute kidney injury
  • Copyright © 2022 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 33 (3)
Journal of the American Society of Nephrology
Vol. 33, Issue 3
March 2022
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Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges
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Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges
Dorian Nezam, Raphaël Porcher, François Grolleau, Pauline Morel, Dimitri Titeca-Beauport, Stanislas Faguer, Alexandre Karras, Justine Solignac, Noémie Jourde-Chiche, François Maurier, Hamza Sakhi, Khalil El Karoui, Rafik Mesbah, Pierre Louis Carron, Vincent Audard, Didier Ducloux, Romain Paule, Jean-François Augusto, Julien Aniort, Aurélien Tiple, Cédric Rafat, Séverine Beaudreuil, Xavier Puéchal, Pierre Gobert, Ziad Massy, Catherine Hanrotel, Stéphane Bally, Nihal Martis, Cécile-Audrey Durel, Geoffroy Desbuissons, Pascal Godmer, Aurélie Hummel, François Perrin, Antoine Néel, Claire De Moreuil, Tiphaine Goulenok, Dominique Guerrot, Steven Grange, Aurélie Foucher, Alban Deroux, Carole Cordonnier, Céline Guilbeau-Frugier, Anne Modesto-Segonds, Dominique Nochy, Laurent Daniel, Anissa Moktefi, Marion Rabant, Loïc Guillevin, Alexis Régent, Benjamin Terrier, on behalf of the French Vasculitis Study Group*
JASN Mar 2022, 33 (3) 628-637; DOI: 10.1681/ASN.2021060771

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Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges
Dorian Nezam, Raphaël Porcher, François Grolleau, Pauline Morel, Dimitri Titeca-Beauport, Stanislas Faguer, Alexandre Karras, Justine Solignac, Noémie Jourde-Chiche, François Maurier, Hamza Sakhi, Khalil El Karoui, Rafik Mesbah, Pierre Louis Carron, Vincent Audard, Didier Ducloux, Romain Paule, Jean-François Augusto, Julien Aniort, Aurélien Tiple, Cédric Rafat, Séverine Beaudreuil, Xavier Puéchal, Pierre Gobert, Ziad Massy, Catherine Hanrotel, Stéphane Bally, Nihal Martis, Cécile-Audrey Durel, Geoffroy Desbuissons, Pascal Godmer, Aurélie Hummel, François Perrin, Antoine Néel, Claire De Moreuil, Tiphaine Goulenok, Dominique Guerrot, Steven Grange, Aurélie Foucher, Alban Deroux, Carole Cordonnier, Céline Guilbeau-Frugier, Anne Modesto-Segonds, Dominique Nochy, Laurent Daniel, Anissa Moktefi, Marion Rabant, Loïc Guillevin, Alexis Régent, Benjamin Terrier, on behalf of the French Vasculitis Study Group*
JASN Mar 2022, 33 (3) 628-637; DOI: 10.1681/ASN.2021060771
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