Determinants of renal and patient outcomes in a Spanish cohort of patients with ANCA-associated vasculitis and renal involvement.

The classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) remains controversial. The main objective of this study was to define the respective values of ANCA serotype-based classification, clinicopathological classification, and histopathological classification in predicting patient and renal outcomes in a Spanish cohort of patients with ANCA with specificity for myeloperoxidase, MPO-ANCA, versus ANCA with specificity for proteinase 3, PR3-ANCA. Two hundred and forty-five patients with ANCA-AAV and biopsy-proven renal involvement diagnosed between 2000 and 2104 were recruited in 12 nephrology services. Clinical and histologic data, renal outcomes, and mortality were analyzed. We applied the Chapel Hill Consensus Conference definition with categories for granulomatosis with the polyangiitis (GPA) and microscopic polyangiitis (MPA), the classification based on ANCA specificity, and the histopathological classification proposed in 2010. Eighty-two percent were MPO-ANCA positive and 18.0% PR3-ANCA positive. Altogether, 82.9% had MPA and 17.1% GPA. The median follow-up was 43.2 months (0.1-169.3). Neither ANCA-based serological nor clinical classification was predictive of renal outcomes or patient survival on bivariate or multivariate Cox regression analysis. Histopathological classification was found to predict development of end-stage renal disease (p = 0.005) in Kaplan-Meier analysis. ANCA specificity was more predictive of relapse than clinicopathological classification in multivariate analysis (HR 2.086; 95% CI 1.046-4.158; p = 0.037). In our Spanish cohort, a majority of patients had an MPO-ANCA-AAV. A classification based on ANCA specificity has a higher predictive value for relapse occurrence and could be used for decision-making with respect to induction treatment and maintenance therapies.

SU-E-I-32: Sterile Radiation Reduction Gloves May Be Contraindicated in Fluoroscopically Guided Interventions.

PURPOSE: Sterile radiation reduction gloves have been widely used in the past decade to provide modest decreases in operator hand dose when the hands are placed in the field of view (FOV). While multiple publications have quantified the potential dose reduction from the use of such gloves, possible effects on the patient have not yet been assessed. The aim of this study was to determine if radiation reduction gloves can Result in a significant increase in patient dose and increased risk of radiation induced skin injury when used in interventional radiology. METHODS: The effect of radiation reduction gloves when used in the FOV was determined by measurement of patient entrance exposure rate (EER) for a variety of patient sizes and varying operating and magnification modes. EERs were measured with no glove in the FOV, with one glove and, to replicate the actions of many dose-conscious radiologists, with double gloves in the FOV. RESULTS: Compared to an ungloved hand, the use of a single radiation reduction glove near the center of the FOV results in a 2-fold average increase in patient EER. The use of double radiation reduction gloves results in a 3-fold average increase in EER. In both cases, this increase was only weakly dependent on the size of the patient and on the operating and magnification modes used. In fact, patient thicknesses ranging from 6-14 inches and operating modes ranging from low-dose fluoroscopy to DSA produced less than a 20% deviation from the increases in EER quoted above. CONCLUSIONS: When used in the FOV, radiation reduction gloves can substantially increase patient EER. This increase in patient dose, when compared with the relatively small published reduction in extremity dose provided to the operator, may make their use contraindicated in cases where radiation induced skin injury is a possible risk.