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Master Thesis

Identification de facteurs pronostiques de survie rénale et globale dans la maladie des anticorps anti-membrane basale glomérulaire : à partir d’une étude multicentrique française de 119 patients

Abstract : Objective: to report the overall and renal long-term outcome in anti-glomerular basement membrane (anti-GBM) disease. Methods: we retrospectively analyzed medical charts of a multicenter cohort of patients with a diagnosis of anti-GBM disease. Results: 119 patients were included [median age 54 years, 42% smokers], among which 54% had an exclusive renal involvement and 6% an isolated alveolar hemorrhage. Initial renal replacement therapy (RRT) was required in 78% of patients; 82% received plasmapheresis, 82% cyclophosphamide, and 9% rituximab. ANCA were positive in 28% of patients, who were older (70 vs. 47 years, p<0.0001), less frequently smokers (26 vs. 54%, p=0.03) and had less pulmonary involvement than ANCA- patients. At M3, 46% of patients had reached end-stage renal disease (ESRD). They were older (57 vs. 37 years, p=0.003) and more frequently male (56 vs 41%) with a more severe renal involvement at presentation [serum creatinine 807 vs 351 µmol/L, p<0.0001] than ESRD- patients. The overall survival (OS) was 95% at 1 year and 92% at 3 and 5 years. Eleven (9.2%) patients died during the follow-up, 3 of them from cancers. Risk factors of death were age at onset [HR 4.10 per decade (1.89-8.88) p=0.003], medical history of hypertension [HR 19.9 (2.52-157.2) p=0.005] and dyslipidemia [HR 11.1 (2.72-45) p=0.0008] and need for initial RRT (p<0.0001) or mechanical ventilation [HR 5.20 (1.02-26.4) p=0.047]. The use of plasmapheresis was associated with better survival [HR 0.29 (0.08-0.98) p=0.046]. Conclusion: this large French nationwide cohort describes the prognosis factors of renal and overall survival in anti-GBM patients.
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Master Thesis
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Cindy Marques. Identification de facteurs pronostiques de survie rénale et globale dans la maladie des anticorps anti-membrane basale glomérulaire : à partir d’une étude multicentrique française de 119 patients. Médecine humaine et pathologie. 2018. ⟨dumas-02293118⟩

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