Wilkowski et al evaluated patients with idiopathic renal vasculitis and focal segmental necrotizing vasculitis. They identified risk factors affecting overall and renal failure free survival. The authors are from the Mayo Clinic.
Patient selection: Based on exclusion of many autoimmune diseases associated with glomerulonephritis (see page 1133). Microscopic polyangiitis could explain some of the cases. The patients were evaluated at the Mayo Clinic from 1970 to 1984.
Parameters:
(1) serum creatinine in mg/dL
(2) white blood cell count
Serum Creatinine mg/dL
WBC Count per µL
5 Year Patient Survival
Survival Free of Renal Failure at 5 Years
< 4
<= 8,000
68%
65%
< 4
8,001 - 12,000
70%
78%
< 4
12,001 - 16,000
65%
65%
< 4
> 16,000
14%
15%
>= 4
NA
30%
45%
from Figures 3 and 4, page 1139
where:
• According to the abstract (page 1133), overall survival free of renal failure is lower than patient survival by definition. The data above seems to go against this definition.
• The laboratory values appear to be based on the first day of evaluation at the Mayo Clinic and prior to any therapy. The interval between onset and referral was not clear.
Limitations:
• Management of patients with autoimmune diseases and renal failure has improved, so survival today is likely to be better.
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