The predictive value of kidney biopsy in renal vasculitis: a multicenter cohort study

Díaz-Crespo, Francisco; Villacorta, Javier; Acevedo, Mercedes; Cavero, Teresa; Guerrero, Carmen; Díaz, Eugenio García; Orradre, J L; Martı́nez, Miguel Ángel; Praga, Manuel; Fernández-Juárez, Gema

doi:10.1016/j.humpath.2016.01.015

Cited by 28 publications

(11 citation statements)

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“…Several reports have been written on the relationship between global sclerosis and the ratio of crescent formation in ANCA-associated vasculitis-associated glomerulonephritis. The sclerotic type of vasculitis-associated glomerulonephritis consisting of primarily global sclerosis reportedly had a worse renal prognosis than the crescentic type with a large crescentic ratio, similar to the results of the present study [ 17 , 18 ]. The percentage of normal glomeruli as well as global glomerulosclerosis was also considered important in previous reports [ 17 , 19 ]; however, multivariate analysis of the percentage of normal glomeruli in patients with MPA only revealed that total nodal sclerosis was a significant factor associated with renal prognosis (Supplementary Table 1 ).…”

Section: Discussionsupporting

confidence: 90%

Analysis of Various Types of Glomerulonephritis with Crescents at a Single Center

Karasawa

Miyabe

2022

International Journal of Nephrology

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Background. The importance of crescent formation in glomerulonephritis has increased. However, detailed analysis of crescentic glomerulonephritis in Asia is scarce. In addition, advances in serological diagnostic techniques (antineutrophil cytoplasmic and antiglomerular basement membrane autoantibodies) and early diagnosis have reduced the number of cases meeting the strict definition of crescentic glomerulonephritis (>50% of glomeruli are crescentic). Therefore, we analyzed the clinicopathological features and renal prognosis of glomerulonephritis cases that exhibited at least one crescentic lesion. Methods. We retrospectively evaluated 265 adult patients diagnosed with glomerulonephritis with at least one crescent formation based on the results of renal biopsy. We divided the patients into two groups based on the four types of glomerulonephritis, namely, the immune-complex (type II: IgA nephropathy, IgA vasculitis with nephritis, and lupus nephritis) and pauci-immune (type III: microscopic polyangiitis) groups. Factors affecting renal prognosis (end-stage renal failure requiring renal replacement therapy) were examined in a multivariate analysis using the Cox proportional hazards model. Kaplan–Meier curves and log-rank test were used to analyze and compare time from entry to renal death. Results. Renal prognosis differed significantly between the immune-complex and pauci-immune groups. Among the four types of glomerulonephritis, IgA nephropathy was the most prevalent. Multivariate analysis showed that renal function at renal biopsy and the ratio of global sclerosis independently predicted renal prognosis, but the type of glomerulonephritis was not a factor. Conclusions. Renal dysfunction at renal biopsy and the ratio of global sclerosis predicted renal prognosis, because it reflects the degree of irreversible renal damage. We also suspect that the formation of at least one crescentic lesion led to the development of these predictive factors, regardless of the type of glomerular disease and degree of crescent formation.

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Section: Discussionsupporting

confidence: 90%

Analysis of Various Types of Glomerulonephritis with Crescents at a Single Center

Karasawa

Miyabe

2022

International Journal of Nephrology

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“…Derived from these studies, a histopathological subgrouping into four classes (focal, crescentic, mixed, and sclerotic), as defined by Berden et al, was shown to predict long-term renal survival rates [ 7 ]. These results were confirmed in multiple independent studies in recent years [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, multivariable analyses could not demonstrate any improvement of outcome prediction in most of these studies, mainly attributed to the lack of outcome difference in the crescentic and mixed classes [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

Section: Introductionsupporting

confidence: 80%

Systematic Scoring of Tubular Injury Patterns Reveals Interplay between Distinct Tubular and Glomerular Lesions in ANCA-Associated Glomerulonephritis

Hakroush

Tampe

Korsten

et al. 2021

JCM

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Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis, most frequently presenting as microscopic polyangiitis (MPA) or granulomatosis with polyangiitis (GPA). Acute tubular injury with the presence of tubulitis was previously reported to be of prognostic value in ANCA glomerulonephritis (GN). In particular, distinct tubular injury lesions were associated with the deterioration of kidney function at AAV disease onset, as well as renal resistance to treatment, and higher risk of progression to composite outcome in patients with AAV. To expand our knowledge regarding distinct tubular lesions in AAV, we aimed to describe acute tubular injury patterns in association with glomerular lesions in ANCA GN by systematic histological scoring. Methods: A total number of 48 renal biopsies with confirmed renal involvement of AAV admitted to the University Medical Center Göttingen from 2015 to 2020 were retrospectively examined. By systematic scoring of tubular injury lesions, the association between clinical parameters, laboratory markers, and histopathological findings was explored. Results: We have shown that cellular casts in renal biopsies were frequently observed in the majority of cases with ANCA GN. Furthermore, we showed that tubular epithelial simplification with dilatation correlated with MPA and MPO subtypes, C3c hypocomplementemia, severe renal involvement, and uACR. Red blood cell (RBC) casts were associated with increased levels of C-reactive protein (CRP), leukocyturia, and hematuria. Finally, we found that hyaline casts were associated with an increased fraction of glomeruli with global glomerular sclerosis. Conclusions: Acute tubular injury patterns were correlated with active ANCA GN, whereas tubular injury lesions reflecting the later stages of kidney disease correlated with chronic glomerular lesions. These results suggest an interplay between different renal compartments.

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“…Since 2010, 21 studies from Asia (8)(9)(10)(11)(12)(13)(14)(15), North America (16)(17)(18), Australia (19), and Europe (14,(20)(21)(22)(23)(24)(25)(26)(27) have validated the histopathologic classification in adults, and four studies validated the classification in pediatric patients (14,(28)(29)(30). The results from some of these studies were recently incorporated into a metaanalysis showing that all validation studies reported the best kidney outcomes in the focal class and the worst in the sclerotic class (13).…”

Section: Introductionmentioning

confidence: 99%

Developments in the Histopathological Classification of ANCA-Associated Glomerulonephritis

Daalen¹,

Trejo²,

Göçeroğlu³

et al. 2020

CJASN

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Background and objectivesThe histopathologic classification for ANCA-associated GN distinguishes four classes on the basis of patterns of injury. In the original validation study, these classes were ordered by severity of kidney function loss as follows: focal, crescentic, mixed, and sclerotic. Subsequent validation studies disagreed on outcomes in the crescentic and mixed classes. This study, driven by the original investigators, provides several analyses in order to determine the current position of the histopathologic classification of ANCA-associated GN.Design, setting, participants, & measurementsA validation study was performed with newly collected data from 145 patients from ten centers worldwide, including an analysis of interobserver agreement on the histopathologic evaluation of the kidney biopsies. This study also included a meta-analysis on previous validation studies and a validation of the recently proposed ANCA kidney risk score.ResultsThe validation study showed that kidney failure at 10-year follow-up was significantly different between the histopathologic classes (P<0.001). Kidney failure at 10-year follow-up was 14% in the crescentic class versus 20% in the mixed class (P=0.98). In the meta-analysis, no significant difference in kidney failure was also observed when crescentic class was compared with mixed class (relative risk, 1.15; 95% confidence interval, 0.94 to 1.41). When we applied the ANCA kidney risk score to our cohort, kidney survival at 3 years was 100%, 96%, and 77% in the low-, medium-, and high-risk groups, respectively (P<0.001). These survival percentages are higher compared with the percentages in the original study.ConclusionsThe crescentic and mixed classes seem to have a similar prognosis, also after adjusting for differences in patient populations, treatment, and interobserver agreement. However, at this stage, we are not inclined to merge the crescentic and mixed classes because the reported confidence intervals do not exclude important differences in prognosis and because an important histopathologic distinction would be lost.

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The predictive value of kidney biopsy in renal vasculitis: a multicenter cohort study

Cited by 28 publications

References 28 publications

Analysis of Various Types of Glomerulonephritis with Crescents at a Single Center

Analysis of Various Types of Glomerulonephritis with Crescents at a Single Center

Systematic Scoring of Tubular Injury Patterns Reveals Interplay between Distinct Tubular and Glomerular Lesions in ANCA-Associated Glomerulonephritis

Developments in the Histopathological Classification of ANCA-Associated Glomerulonephritis

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