Comparison of the clinicopathological characteristics of children with anti-neutrophil cytoplasmic antibody-associated vasculitis with/without infection at diagnosis

Background: Infectious episodes contribute to morbidity and mortality in patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Renal involvement, also known as ANCA-associated glomerulonephritis (AGN), is frequently observed in AAV. Little is known about whether co-infection at initial diagnosis is associated with renal outcome and prognosis in children with AGN.

Methods: Clinical and prognostic data for children admitted to our center with AAV from January 2001 to August 2023 were analyzed retrospectively. We compared the incidence of end-stage renal disease (ESRD) and mortality according to infection status at initial diagnosis.

Results: A total of 33 children with AGN were included in this study, 22 had an infection at the time of AGN diagnosis. A trend toward higher levels of proteinuria in the infected group than in the non-infected group was observed (p = 0.42). Patients in the infected group had higher creatinine and lower eGFR values than those in the non-infected group (p = 0.09). A significant decrease in HGB was observed in the infected group (p < 0.05). There were no significant differences in the baseline values of ALB and complement c3 between the two groups. A similar proportion of patients in both groups required dialysis at the time of diagnosis (27.3% vs. 31.8%). Patients with infection presented with significantly greater ESR and CRP levels (p < 0.05), and the most commonly infected site was the lung. After 6 months of treatment, compared with those in the non-infected group, the median levels of creatinine and proteinuria were higher in the infected group. Besides, lower levels of eGFR and ALB were also observed in the infected group. 5 (45.5%) and 13 (59.1%) patients died or progressed to ESRD, respectively, in the non-infected group and infected group at the last follow-up.

Conclusions: Infection at initial diagnosis does not affect the outcomes of children with AGN, although it could lead to a reduction in kidney function.