Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors
File(s)
Author(s)
Type
Journal Article
Abstract
Background Anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis with renal involvement requires treatment with potentially toxic drugs to reduce morbidity and mortality, and there is a major challenge to determine clinical and histological features predictive of renal prognosis. The aim of our study was to evaluate the use of the 2010 international histological classification for ANCA-associated glomerulonephritis (AAGN) as a predictor of renal outcome when used in conjunction with other prognostic factors.
Methods One hundred and four patients with AAGN treated at our centre were included: 23 were classified as focal, 26 as crescentic, 48 as mixed and 7 as sclerotic. Renal outcomes were based on estimated glomerular filtration rate (eGFR) at 1 and 5 years, and on renal survival.
Results By univariate analysis, patients in the focal class had the best renal outcome, those in the sclerotic class the worst outcome, and those in the mixed and crescentic classes had intermediate renal survival. There was no significant difference in outcome between the mixed and crescentic classes. In multivariate models, histological class did not improve model fit or associate with renal outcome after adjusting for established prognostic factors. Lower percentage of normal glomeruli, greater degree of tubular atrophy (TA), MPO-ANCA positivity, increasing age and lower starting eGFR, all correlated with poorer renal outcomes.
Conclusions We conclude that, in our cohort of patients, the international histological classification is predictive of renal outcome in AAGN, but did not appear to be additionally informative over other established prognostic factors in multivariate analysis. However, it may be of value to combine the current histological classification with other established parameters, such as TA and percentage normal glomeruli.
Methods One hundred and four patients with AAGN treated at our centre were included: 23 were classified as focal, 26 as crescentic, 48 as mixed and 7 as sclerotic. Renal outcomes were based on estimated glomerular filtration rate (eGFR) at 1 and 5 years, and on renal survival.
Results By univariate analysis, patients in the focal class had the best renal outcome, those in the sclerotic class the worst outcome, and those in the mixed and crescentic classes had intermediate renal survival. There was no significant difference in outcome between the mixed and crescentic classes. In multivariate models, histological class did not improve model fit or associate with renal outcome after adjusting for established prognostic factors. Lower percentage of normal glomeruli, greater degree of tubular atrophy (TA), MPO-ANCA positivity, increasing age and lower starting eGFR, all correlated with poorer renal outcomes.
Conclusions We conclude that, in our cohort of patients, the international histological classification is predictive of renal outcome in AAGN, but did not appear to be additionally informative over other established prognostic factors in multivariate analysis. However, it may be of value to combine the current histological classification with other established parameters, such as TA and percentage normal glomeruli.
Date Issued
2014-07-12
Date Acceptance
2014-06-10
Citation
Nephrology Dialysis Transplantation, 2014, 30 (7), pp.1185-1192
ISSN
1460-2385
Publisher
Oxford University Press (OUP)
Start Page
1185
End Page
1192
Journal / Book Title
Nephrology Dialysis Transplantation
Volume
30
Issue
7
Copyright Statement
© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Nephrology Dialysis Transplantation following peer review. The version of record Anisha Tanna, Laura Guarino, Frederick W.K. Tam, Beatriz Rodriquez-Cubillo, Jeremy B. Levy, Tom D. Cairns, Megan Griffith, Ruth M. Tarzi, Benjamin Caplin, Alan D. Salama, Terence Cook, and Charles D. Pusey
Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors
Nephrol. Dial. Transplant. (2015) 30 (7): 1185-1192 first published online July 12, 2014 is available online at: https://dx.doi.org/10.1093/ndt/gfu237.
Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors
Nephrol. Dial. Transplant. (2015) 30 (7): 1185-1192 first published online July 12, 2014 is available online at: https://dx.doi.org/10.1093/ndt/gfu237.
Sponsor
National Institute for Health Research
Grant Number
NF-SI-0611-10055
Subjects
Science & Technology
Life Sciences & Biomedicine
Transplantation
Urology & Nephrology
ANCA
clinical outcome
glomerulonephritis
renal pathology
vasculitis
ANCA-ASSOCIATED VASCULITIS
(ANCA)-ASSOCIATED GLOMERULONEPHRITIS
HISTOPATHOLOGIC CLASSIFICATION
NEPHROPATHY
RITUXIMAB
THERAPY
Publication Status
Published