Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis

Abstract

We demonstrated the clinical utility of histopathologic classification in determining renal outcome in patients with AAV. Metaanalysis showed that patients with focal class had the best outcome while sclerotic class had the worst.

Histopathological subgrouping versus renal risk score for the prediction of end-stage renal disease in ANCA-associated vasculitis

“…To date, reported predictors of renal outcome are mainly patients’ age, severe renal dysfunction and histopathological findings at presentation 1 2. Histopathological classification as defined by Berden et al was proposed to be helpful with the highest renal survival rates in the focal group and the poorest in the sclerotic group 3 4. Recently, Brix et al suggested the antineutrophil cytoplasmic antibody renal risk score (ARRS) to predict ESRD in patients with AAV 5.…”

Renal Involvement in Rheumatic Diseases

“…In a histologic sense, severity of acute lesions, such as glomerular crescents and fibrinoid necrosis, rather than chronic lesion-like glomerular sclerosis is well correlated with renal outcome and responsiveness of immunosuppressants in several renal vasculitides associated with AAV [29,33,34]. Classification of ANCA-associated glomerulonephritis based on renal biopsy results has been developed for the prognosis of renal vasculitis [29,33,34].…”

“…As mentioned earlier, the renal outcome of ANCA-associated renal vasculitis is mainly related to GFR at onset time of renal disease and specific pathologic findings including several glomerular damages, interstitial fibrosis, and tubular atrophy rather than the serum ANCA level. However, according to several studies [33,34,37]. The treatment of ANCA-associated renal vasculitis is mainly composed of high-dose glucocorticoid and systemic cyclophosphamide for three months or six months in induction therapy.…”

“…Classification of ANCA-associated glomerulonephritis based on renal biopsy results has been developed for the prognosis of renal vasculitis [29,33,34]. 'Focal' lesion represents a relatively preserved renal function and 'crescentic' lesion shows a good responsiveness for immunosuppressant therapy.…”

“…We can clinically recognize the presence of renal involvement of AAV by identifying hematuria, proteinuria, azotemia, edema, and hypertensive symptoms [30]. Although glomerular filtration rate (GFR) at onset time of renal vasculitis associated with AAV reflects a renal outcome, renal histologic feature is also an important predictor for disease outcome particularly in the renal vasculitis associated with AAV [29,33].…”