Predictors of renal outcomes in anti-neutrophil cytoplasmic antibody glomerulonephritis

Jebali, H.; Khadhar, M.; Mami, I.; Boussaid, S.; Sellami, Mokhtar; Hassen, Mohaned; Hmida, F. Ben; Chermiti, Mohamed; Ghabi, H.; Salem, T. Ben; Houman, Hbib; Raîs, L.; Zouaghi, Mohamed Karim

doi:10.4103/1319-2442.279939

Cited by 11 publications

(10 citation statements)

References 31 publications

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“…Supplementary Figure S1 reports the renal biopsy findings in the ESKD risk cohort (n=123). The light microscopy specimen contained a median of 20 ( 13 – 26 ) glomeruli and a median proportion of normal, crescentic, and sclerotic glomeruli of 29% [13–47], 43% [29–61], and 12% [5–34], respectively. IFTA involving more than 25% of the biopsy; ATN and fibrinoid necrosis were observed in 42 (34.1%), 88 (71%), and 90 (72.6%) biopsies, respectively.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…This score was designed to predict ESRD risk as low (0 points), medium (2 to 7 points), or high (8 to 11 points), and it proved to be a clinically applicable tool for early risk prediction of ESRD in ANCA-GN. Validation of the RRS was performed in 11 cohorts worldwide, comprising 37 to 252 patients, and showed its predictive value [5][6][7][8][9][10][11][12][13][14][15]. However, regarding discrimination and calibration, the two key aspects of a systematic assessment of predictive performance for a model, most of the previous validation studies did not report discrimination [5,6,8,9,[12][13][14][15], and none of them reported calibration [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

“…Validation of the RRS was performed in 11 cohorts worldwide, comprising 37 to 252 patients, and showed its predictive value [5][6][7][8][9][10][11][12][13][14][15]. However, regarding discrimination and calibration, the two key aspects of a systematic assessment of predictive performance for a model, most of the previous validation studies did not report discrimination [5,6,8,9,[12][13][14][15], and none of them reported calibration [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

A modified renal risk score for Chinese patients with antineutrophil cytoplasmic antibody-associated vasculitis

Wang

Chen

et al. 2023

BMC Med

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Background The renal risk score (RRS) is a useful tool to predict end-stage renal disease (ESRD) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The current study aimed to validate the predictive performance of RRS and to further modify this model in Chinese AAV patients. Methods Two hundred and seventy-two patients diagnosed with AAV confirmed by renal biopsies were retrospectively enrolled from a single center. The RRS was calculated based on 3 categorical variables, i.e., the proportion of normal glomeruli, the proportion of interstitial fibrosis and tubular atrophy (IF/TA), and eGFR at biopsy, classifying these patients into low-, medium-, and high-risk groups. In addition, a modified model was developed based on the RRS and was further validated in another independent cohort of 117 AAV patients. The predictive performance of each model was evaluated according to discrimination and calibration. Results Patients were classified by the RRS into low- (26.5%), medium- (46.7%), and high-risk (26.8%) groups, with 120-month renal survival rates of 93.3%, 57.2%, and 18.4%, respectively (P < 0.001). The RRS showed good discrimination but less satisfactory calibration. Therefore, a modified model with improved discrimination and calibration was developed in Chinese AAV patients, with eGFR, proportion of normal glomeruli (both as continuous variables), and IF/TA (< 25%, 25–50%, > 50%) included. Internal and external validation of the modified model were performed. Finally, an online risk prediction tool was developed based on the modified model. Conclusions The RRS was an independent predictor of ESRD of AAV patients. The modified model could predict the probability of ESRD for AAV patients with improved performance in Chinese AAV patients.

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“…And unlike CYC, MMF is irrelevant to urothelial malignancy or infertility (10). AAV is a heterogeneous group of inflammatory diseases that affects the small vasculatures in multiple organs, but primarily the kidneys (11). MMF has been used as a remission induction therapy in AAV patients with CYC failure or intolerance (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

“…However, only several small open-label studies (11,(17)(18)(19) compared the use of MMF to CYC in AAV induction therapy. The results of Hu et al (17) showed that MMF led to a lower Birmingham Vasculitis Activity Score (BVAS) value compared with CYC for remission induction therapy in AAV and other three studies (11,18,19) found no difference between MMF and CYC in microscopic polyangiitis. There is no enough evidence to recommend the use of MMF in the induction therapy of AAV, thus, we conduct a meta-analysis to evaluate the role of MMF for the induction of remission in patients with AAV.…”

Section: Introductionmentioning

confidence: 99%

The Role of Mycophenolate Mofetil for the Induction of Remission in ANCA-Associated Vasculitis: A Meta-Analysis

Xiong

Yang

et al. 2021

Front. Med.

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Objectives: The successful introduction of mycophenolate mofetil (MMF) as a treatment for renal allograft reduced the incidence of acute rejection. The inspiring effects obtained by the MMF have led to an evaluation of its therapeutic potency on ANCA-associated vasculitis (AAV). However, there is little evidence of the MMF's efficacy on the AAV. The meta-analysis is carried out to evaluate the efficacy of MMF as a remission induction therapy in AAV.Methods: Up to June 30th, 2020, PubMed, Cochrane Library, and Embase have been searched comprehensively. According to heterogeneity, the pooled remission rates are synthesized by either fixed-effect or random-effect models.Results: The eight included studies comprising 230 patients who were treated with MMF as induction therapy are included in our analysis. The pooled overall remission rate is 74% (95% CI: 0.68–0.80). The remission rate, the infection rate and the rate of leukopenia of four randomized controlled trials aimed at comparing the effects of MMF with cyclophosphamide (CYC) during induction therapy for AAV have no statistical significance (P > 0.05).Conclusion: MMF may be an alternative to CYC for remission induction therapy in AAV with MPO-ANCA, mild to moderate renal involvement and non-life-threatening state. Whether to observe the effect of MMF in AAV or to compare the difference between MMF and CYC in the future studies, risk stratification and subgrouping of AAV patients should be first carried out to correctly identify the AAV subgroup suitable for MMF.

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Predictors of renal outcomes in anti-neutrophil cytoplasmic antibody glomerulonephritis

Cited by 11 publications

References 31 publications

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

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

A modified renal risk score for Chinese patients with antineutrophil cytoplasmic antibody-associated vasculitis

The Role of Mycophenolate Mofetil for the Induction of Remission in ANCA-Associated Vasculitis: A Meta-Analysis

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