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

Gerçik, Önay; Bılgın, Emre; Solmaz, Dilek; Çakalağaoğlu, Fulya; Saglam, Arzu; Aybi, Özge; Kardaş, Rıza Can; Soypaçacı, Zeki; Kabadayi, G.; Yıldırım, Tolga; Aysin, Idil Kurut; Karadağ, Ömer; Akar, Servet

doi:10.1136/annrheumdis-2019-216742

Cited by 20 publications

(15 citation statements)

References 5 publications

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“…However, although these clinicopathologic variables were aggregated, the renal prognosis of the lowand medium-risk groups did not differ in the Korean cohort. A recent Turkish study also reported the same results as in this study [28]. There are some possible reasons for this inconsistent result.…”

Section: Discussionsupporting

confidence: 73%

Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Lim

Han

Kim

et al. 2021

Kidney Res Clin Pract

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Background: Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) is a common cause of rapidly progressive glomerulonephritis and requires prompt and proper immunosuppressive therapy to improve renal prognosis. This study aimed to evaluate the predictive value of two different classifications for renal outcomes in Korean AAGN patients. Methods: Ninety-two patients who were diagnosed with AAGN at two tertiary hospitals between 2004 and 2018 were retrospectively analyzed retrospectively. The histopathologic classification according to glomerular pathology and the clinicopathologic classification according to normal glomeruli ratio, degree of interstitial fibrosis/tubular atrophy, and baseline renal function were evaluated using the Cox proportional hazards model. Results: Forty-five patients (48.9%) progressed to end-stage kidney disease (ESKD) during the observation period. The mean age was 61.0 ± 15.3 years, and most patients had myeloperoxidase-ANCA (93.5%). In the histopathologic classification, the best renal survival occurred in the focal class, whereas the sclerotic class had the worst renal survival (sclerotic class vs. focal class; adjusted hazard ratio [aHR], 5.05; 95% confidence interval [CI], 1.32-19.31; p = 0.018). The mixed class had intermediate renal outcomes (mixed class vs. focal class; aHR, 4.23; 95% CI, 1.23-14.58; p = 0.022). In the clinicopathologic classification, the high-risk group had poor renal outcomes compared with the low-risk group (aHR, 6.56; 95% CI, 1.25-34.26; p = 0.026), but renal outcomes did not differ between the low-and medium-risk groups.

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Section: Discussionsupporting

confidence: 73%

Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Lim

Han

Kim

et al. 2021

Kidney Res Clin Pract

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“…A recent cohort from Turkey demonstrated similar findings to the initial German cohort investigated by Brix et al (7). The rates of kidney failure were 8%, 42%, and 67% in the low-, medium-, and high-risk groups, respectively, over a median follow-up of 39 months (10). A further cohort from Mexico enriched with mixed and sclerotic class GN, a group at high risk of progression to kidney failure, confirmed the risk groups' distinction.…”

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confidence: 72%

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Brix

Geetha

2020

CJASN

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“…Brix et al developed a renal risk score system based on tubular atrophy, interstitial fibrosis, the proportion of normal glomeruli, and eGFR at diagnosis (24). Another study found that the renal risk score which combines histologic and laboratory features performs better in predicting the renal outcome (25). BVAS at admission were independent risk factors of ESRD or mortality.…”

Section: Discussionmentioning

confidence: 99%

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Kidney Injury: Short-Term Recovery Predicts Long-Term Outcome

et al. 2021

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BackgroundKidney involvement is common in antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). It tends to be aggressive, and in some patients, the kidney involvement may reach the criteria of acute kidney injury (AKI). Here, we aim to describe the clinical characteristics of these patients and find risk factors for poor outcomes.MethodsPatients diagnosed with AAV in our hospital from February 2003 to February 2017 were included. Those who reached the KDIGO AKI criteria were reclassified according to the KDIGO AKI stage. The clinical features of these patients were analyzed. Also, according to the variation of serum creatinine 3 months after AKI episode, patients were further divided into two groups: patients whose serum creatinine (Scr) level at the third month decreased by 30% or more from the peak Scr level was classified into G1 and others were classified into G2. Long-term renal and survival outcomes of these patients were analyzed with a Cox model. The renal endpoint was reaching end-stage renal disease (ESRD), and the survival endpoint was death. Nomograms were built based on cox models.ResultsOf 141 AAV patients included, during the median follow-up period of 64.0 (IQR 34.8, 85.4) months, 36 (25.5%) patients reached renal endpoints, and 22 (15.6%) patients died. The median renal survival time was 35.9 (IQR 21.3, 72.6) months and the median survival time was 48.4 (IQR 26.8, 82.8) months. Multivariate analysis showed that poor recovery of Scr level at 90 days (P < 0.001, RR = 9.150, 95%CI 4.163–20.113), BVAS score (P = 0.014, RR = 1.110, 95% CI1.021–1.207), and AKI stage 3 (P = 0.012 RR = 3.116, 95%CI 1.278–7.598) were independent risk factors for renal endpoints; poor recovery of Scr level at 90 days (P = 0.010, RR = 3.264, 95%CI 1.326–8.035), BVAS score (P = 0.010, RR = 1.171, 95%CI 1.038–1.320) and age (P = 0.017, RR = 1.046, 95%CI 1.008–1.086) were independent risk factors for all-cause death. The c-index of nomograms is 0.830 for the renal outcome and 0.763 for the survival outcome.ConclusionKDIGO AKI stage 3 is the risk factor for ESRD in AAV patients with AKI. The BVAS score and level of kidney function recovery at 90 days are the independent risk factors for both ESRD and all-cause death and are of predictive value for the outcome.

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

Cited by 20 publications

References 5 publications

Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Keeping Up with the Times

Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Kidney Injury: Short-Term Recovery Predicts Long-Term Outcome

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