Assessment of Renal Risk Score and Histopathological Classification for Prediction of End-Stage Kidney Disease and Factors Associated With Change in eGFR After ANCA-Glomerulonephritis Diagnosis

Abstract

IntroductionThe “Renal Risk Score” (RRS) and the histopathological classification have been proposed to predict the risk of end-stage kidney disease (ESKD) in ANCA-associated glomerulonephritis (ANCA-GN). Besides, factors associated with kidney function recovery after ANCA-GN onset remain to be more extensively studied. In the present study, we analyzed the value of the RRS and of the histopathological classification for ESKD prediction. Next, we analyzed factors associated with eGFR change within the first 2 years following ANCA-GN diagnosis.Materials and MethodsWe included patients from the Maine–Anjou ANCA-associated vasculitis registry with at least 6 months of follow-up. The values of ANCA-GN, histopathological classification, and RRS, and the factors associated with eGFR variations between ANCA-GN diagnosis and 2 years of follow-up were assessed.ResultsThe predictive values of the histopathological classification and RRS were analyzed in 123 patients. After a median follow-up of 42 months, 33.3% patients developed ESKD. The predictive value of RRS for ESKD was greater than that of the histopathological classification. Determinants of eGFR variation were assessed in 80/123 patients with complete eGFR measurement. The median eGFR increased from ANCA-GN diagnosis to month 6 and stabilized thereafter. The only factor associated with eGFR variation in our study was eGFR at ANCA-GN diagnosis, with higher eGFR at diagnosis being associated with eGFR loss (p<0.001).ConclusionThe RRS has a better predictive value for ESKD than the histopathological classification. The main determinant of eGFR variation at 2 years was eGFR at ANCA-GN diagnosis. Thus, this study suggests that eGFR recovery is poorly predicted by histological damage at ANCA-GN diagnosis.

The predictive value of Berden's classification versus renal risk score for renal survival of Chinese patients with myeloperoxidase-anti-neutrophil cytoplasmic antibody-associated glomerulonephritis

“…The average follow-up time of our study (38.99 months) was similar with that of Brix's study (34 months), but the average follow-up time was shorter in Luo's study (14.3 months) (28). Till now, some reports have evaluated the prognostic value of Berden's classification and RRS, and found that RRS showed better discrimination than Berden's classification for predicting overall renal survival (13,29). However, these studies only evaluated predictive value in terms of discrimination ability and compared predictive ability for overall renal survival.…”

“…Since the publication of Berden's classification, its predictive value for renal survival has been verified in many studies. Among the four groups of Berden's classification, the patients in the sclerotic group had the worst prognosis and those in the focal group had the best prognosis (13). Different from the focal and sclerotic groups, there was a controversy about renal outcomes of the crescentic and mixed groups.…”

“…Some studies compared the prognostic values of Berden's classification versus RRS for renal outcomes and revealed that RRS had better predictive ability than Berden's classification. However, these studies were limited to comparing discrimination ability and predicting overall survival (13)(14)(15). A more comprehensive comparison between Berden's classification and RRS are needed.…”

Validation of a renal risk score in a cohort of children with ANCA-associated glomerulonephritis

“…According to a research including Japanese adults showed that there was no significant difference between the ARRS and conventional prognostic tools prognostic ability. 14 However, Brilland et al 33 found that the ARRS has a better predictive value for ESKD than the Berden classification. Current study was the first to compare predictive value of ARRS, Berden classification, and RPGN in children with AAGN.…”

The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials

“…24 The ARRS was found to have excellent discrimination, and since its publication, multiple retrospective cohort studies have been performed on cumulatively over 2000 patients across three continents. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] It was recently incorporated into a proposed tool to identify patients who may benefit from plasma exchange after the results of the plasma exchange and glucocorticoid dosing in the treatment of anti-neutrophil cytoplasm antibody-associated vasculitis trial. 40,41 A recent meta-analysis of 11 ARRS validations with a median number of 130 patients per study (range, 37-252) highlighted the need for larger-scale studies.…”