ObjectiveTo analyze the clinical characteristics and renal outcome of elderly patients with antineutrophil cytoplasmic autoantibody (ANCA) associated vasculitis (AAV) with renal involvement.
MethodsWe retrospectively analyzed the clinical data of 147 patients with ANCA relate vasculitis treated between June 2006 and June 2012. Based on the age, the patients were divided into elderly group (65 years or older, n=50) and non-elderly group (younger than 65, n=97). The disease course, clinical characteristics, ANCA serological indexes, renal pathological change and prognosis of patients in the two groups were compared and studied.
ResultsIn the elderly group, there were 3 cases of Wegener granulomatosis (WG), 45 of microscopic polyangiitis (MPA), and 2 of pauci-immune crescentic glomerulonephritis (PICGN). The non-elderly group had 8 cases of WG, 82 of MPA, 6 of PICGN, and 1 of allergic angitis granulomatosis. There were 5 cases of positive cANCA and 44 of positive pANCA in the elderly group. The elderly patients had significantly more pulmonary involvement than the younger patients (P=0.030). No significant difference was detected between the two groups in combined pulmonary infection (P=0.281) or combined infectious index C-reactive protein (P=0.326). Elderly patients were less likely to respond to sufficient treatment with pulse intravenous methylprednisolone therapy (P=0.035) and cyclophosphamide (P=0.043), and had worse renal outcome than younger patients (P=0.040).
ConclusionElderly patients with AAV have more prevalent pulmonary involvement and have severe complication of pulmonary infection, which affects mortality and morbidity of ANCA-associated systemic vasculitis.
Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis. Methods This is a retrospective non-comparative interventional clinical research. A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study. Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis. The patients, seven males and two females, aged from 19 to 66 years, with an average of 43.89 years. The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days. Visual acuity, slit lamp ophthalmoscopy, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), hematological and tuberculosis related investigations were examined and analyzed. All patients had standard anti-tuberculosis treatment. Treatment outcomes were followed for six to 37 months with an average of 14.11 months. Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28. Among 11 eyes, six presented mild to moderate vitritis, five presented as retinal vein occlusion with no obvious vitirits. Fundus examination showed six cases with retinal hemorrhage, four cases with macular edema, two with macular epiretinal membrane, and two with vitreous hemorrhage. FFA revealed 11 cases with leakage of vessels, 11 with nonperfusion area, four with macular edema, three with retinal neovascularization, and two with choroidal lesions. OCT of nine eyes suggested six eyes with retinal edema, three with macular edema, three with macular epiretinal membrane. TST of seven patients were all b positive. T-SPOT.TB of four patients were all positive. Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection. Four to six weeks after the start of anti-tuberculosis treatment, vitritis, exudates, retinal and macular edema subsided. During follow up, inflammation was stable with no recurrence observed. The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51. Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis, retinal vein occlusion, and retinal hemorrhage. Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.
