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Background. Renalinvolvementremainsamajordeter-minant in antineutrophil cytoplasmic autoantibody-associated small vessel vasculitis (AASV). While somepatients may develop persistent renal damage, othershave a favourable outcome.Methods. To identify patients at risk for poor renaloutcome, we evaluated 95 renal biopsies (67 initialbiopsies and 28 repeat biopsies) of 67 patients withAASV for the presence and extent of active (AI)and chronic (CI) lesions, retrospectively. AI, CI, levelsof proteinuria and dose of cyclophosphamide (CYC)were related to renal outcome.Results. Recovery of renal function in patients ini-tially dialysis dependent was associated with a lowerCI compared with patients who remained on dialysis(P

Objective To analyze the effect of individual adaptation of the dialysis prescription in continuous ambulatory peritoneal dialysis (CAPD), as compensation for the decline of residual renal function (RRF), on peritoneal (Kpt/V) and total (Kprt/V) urea clearance as well as on peritoneal (Kpcr) and total weekly creatinine clearances (CCr). Design Retrospective analysis of a 2-year period. Patients We analyzed 18 patients [15 male, 3 female; mean age 58.2 (24 – 80) years]. Main Outcome Measures Correlations between increased dialysis prescription and Kpt/V, Kprt/V, and Kpcr. Kprt/V and CCr measurements were based on a 24-hour dialysate and urine collection. Measurements were performed over a time period of 3 to 6 months. Results The results show a linear correlation between Kpt/V and Kpcr and the prescribed volume by kilogram body weight. Kprt/V was increased slightly by increasing the dialysis prescription. Dialysate-to-plasma (D/P) ratios of urea and creatinine remained unchanged. The mean prescribed dialysate volume increased from 7.4 ± 1.1 L to 10.6 ± 2.5 L. Mean Kprt/V could be maintained on a stable level for a 36-month period. Conclusion By adapting the dialysis prescription on an individual basis to the continuous decline of RRF, and taking the patient's body weight into account in the prescription decision, the increases in Kpt/V offset the decline in RRF. We recommend early individualization of prescription for patients on CAPD.

Background. In small vessel vasculitis and its renallimited form, idiopathic crescentic glomerulonephritis, renal damage is characterized by pauci-immune necrotizing crescentic glomerulonephritis (CGN) without histological evidence of immunoglobulin (Ig) deposition. In some patients, however, significant amounts of immune deposits may be detected. Therefore, we evaluated the clinical significance of these immune deposits in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune CGN. Methods. Renal biopsies of 45 consecutive patients with new onset of Wegener’s granulomatosis, microscopic polyangiitis and idiopathic CGN were retrospectively evaluated by light microscopy, immunohistochemistry and electron microscopy and the findings compared with renal function and outcome. Results. Typical pauci-immune CGN was found in 37 patients (group I). In eight patients (18%; group II), however, histopathological examination revealed substantial deposition of Ig in the mesangium anduor along the glomerular basement membrane. Five of these eight patients were cANCA positive; two initially had pANCA and developed a cANCA pattern and one was pANCA positive. There were no differences between groups in age, gender, renal function or extrarenal organ involvement at the time of biopsy. However, patients in group II had significantly more proteinuria (5.4"3.1 vs 1.3"1.0 gu24 h; Ps0.016). We also observed a trend for a worse outcome with respect to renal function and mortality in group II patients; however, the differences did not reach significance. Conclusions. Our results confirm that in ANCAassociated CGN a substantial percentage of patients have evidence of Ig deposition in renal biopsies. In this subgroup, Ig deposition was associated with a significantly greater degree of proteinuria. Further investigations are necessary to define the full clinical impact of immune-complex deposition on the clinical course of renal disease in pauci-immune CGN.