Validation of the renal risk score for antineutrophil cytoplasmic antibody-associated glomerulonephritis in a Chinese population

Bai, Xue; Guo, Qi; Lou, Yan; Nie, Ping; Zhu, Yongtong; Li, Bing; Luo, Ping

doi:10.1007/s10067-021-05862-w

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…The RRS has been validated as a good prognostic tool for renal disease in Japan, Korea, Mexico, and Spain [ 5 , 6 , 12 , 13 ]. In the present study, renal prognosis deteriorated sequentially in the low, medium, and high RRS groups, which is consistent with the findings of Brix et al The present study has similar background characteristics to studies in Japan and Korea [ 14 – 16 ], but is in contradiction with their study, which showed a similar prognosis for the medium RRS group and the low RRS group [ 5 , 6 ]. There are several possible reasons for this inconsistency.…”

Section: Discussionsupporting

confidence: 89%

Evaluation of three scoring systems for predicting renal prognosis in antineutrophil cytoplasmic antibody-associated glomerulonephritis

et al. 2023

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Background Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) is characterized by rapidly progressive glomerulonephritis, and timely initiation of treatment and evaluation is critical to prevent the progression of renal disease to end-stage renal disease (ESRD). The aim of this study was to evaluate predictive value of the renal risk score (RRS), Birmingham vasculitis activity score (BVAS), and renal vascular lesions (RVLs) score for renal prognosis in AAGN. Methods A retrospective analysis of ninety-four patients diagnosed with AAGN after renal biopsy was performed. The RRS, BVAS, and RVLs score were evaluated in relation to clinicopathologic features and renal prognosis. A receiver operating characteristic curve (ROC) was used to evaluate their renal prognostic value. Results The median follow-up time was 36 months. Thirty-eight patients progressed to ESRD. Survival analysis showed that renal prognosis worsened in the RRS group in order of low, medium, and high RRS (P < 0.05). Within the RVLs group, the renal prognosis of the groups with severe and moderate RVLs was worse than that of the group without RVLs (P = 0.012, P < 0.001), and the group with mild RVLs was close to that of the group without RVLs. ROC analysis showed that the AUC of RRS, BVAS, RVLs score, RVLs score combined with RRS (RVLs score & RRS, RR), RVLs score, and RRS combined with BVAS (RVLs score & RRS & BVAS, RRB) were 0.865, 0.624, 0.763, 0.910, and 0.942, respectively. The predictive power of RRB and RR was comparable and significantly better than the RRS, BVAS, and RVLs score. Based on simplicity and validity, RR was selected as the best predictor, and the relationship between RRS, RVLs score, and RR was calculated using a linear fit, resulting in the linear equation RR = -0.4766 + 0.1231 × RVLs score + 0.395 × RRS (P < 0.001). Conclusions In AAGN, the predictive power of RR for renal prognosis was superior to that of RRS, BVAS, and RVLs score. RR may serve as a new predictor of renal prognosis in AAGN.

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Section: Discussionsupporting

confidence: 89%

Evaluation of three scoring systems for predicting renal prognosis in antineutrophil cytoplasmic antibody-associated glomerulonephritis

et al. 2023

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“…The possible reason for this controversy may be the difference in time period of follow up. 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).…”

Section: Discussionsupporting

confidence: 84%

“…Finally, the patients can be classified into 3 groups for the risk of ESRD, including the low-, medium-, and high-risk groups (12). Recently, a Chinese research group by Luo et al validated RRS in a group of Chinese patients and found there was no significant difference between the low-and medium-risk groups in Kaplan-Meier analysis by post-hoc tests with Bonferroni correction (28). Interestingly, the present study showed that low-, medium-and high-risk groups had significant differences in post-hoc tests with Bonferroni correction, which was consistent with Brix's results.…”

Section: Discussionmentioning

confidence: 99%

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

Kong

Wang

et al. 2022

Clinical and Experimental Rheumatology

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Objective This study aims to compare the prognostic values of two histopathological classification, Berden's classification versus renal risk score (RRS) by Brix et al. for predicting renal survival in Chinese patients with myeloperoxidaseanti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (MPO-AAGN). Methods The medical records of 225 patients with MPO-AAGN diagnosed in our centre between February 2004 and December 2020 were retrospectively analysed. The predictive model of Berden's classification or RRS was established by Cox regression, respectively. The above two models were compared on aspects of discrimination, calibration, and decisioncurve analysis for predicting the 0.5-, 1-, 3-, and 5-year renal survival. ResultsAfter a median follow up of 38.99 months, 32.44% of patients developed end-stage renal disease (ESRD). In the Kaplan-Meier analysis, there were significant differences in renal survival among groups according to Berden's classification or RRS (both log-rank p<0.001). According to time-dependent receiver operating characteristic (ROC) curve analysis, the model based on RRS showed better discrimination ability than the model based on Berden's classification for predicting 0.5-, 1-, and 3-year renal survival. For calibration analysis, the model based on RRS showed worse calibration than the model based on Berden's classification for predicting 1-and 3-year renal survival.According to the decision curve analysis, the clinical decisions based on RRS could achieve more clinical benefits than those based on Berden's classification in predicting 0.5-, 1-, and 3-year renal survival. ConclusionThe model based on RRS has better predictive value for renal survival than Berden's classification in aspect of discrimination and clinical decision from 0.5-to 3-year renal survival.

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“…However, there is no difference between TA/IF ≤ 25% and TA/IF > 25%, which was consistent with the results of another study on Chinese adults with AAGN. 32 For reasons: First, it may be related to regional, ethnic, and ANCA type. 4 Second, the extent of TA/IF lesions may not be severe in some patients at the time of initial renal biopsy for AAGN and they may become more severe over time as the disease progresses, due to the presence of urine protein persists, and the use of immunosuppressive medicine.…”

Section: Discussionmentioning

confidence: 99%

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

Zhang,

Yao,

Gao

et al. 2023

Journal of Investigative Medicine

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Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is extremely rare in children. Renal involvement is a common and severe complication of AAV as it can cause end stage kidney disease (ESKD). ANCA renal risk score (ARRS) is helpful in predicting long-term ESKD in patients with ANCA-associated glomerulonephritis (AAGN). This retrospective study included 61 consecutive patients with kidney biopsy specimen-proven AAGN from Clinical Center for Children’s Kidney Disease in China. Each patient was assessed by eGFR, normal glomeruli, and tubular atrophy/interstitial fibrosis, and the renal outcome was evaluated using the ARRS. Based on the ARRS, 27 (44.26%), 21 (34.43%), and 13 (21.31%) patients were divided into the low-risk, medium-risk, and high-risk groups, respectively. The median follow-up period was 46.36 (14.58–95.62) months. The high-risk group had worse renal outcomes than the low-risk group (p< 0.05) and the medium-risk group (p < 0.05). COX multivariate regression analysis showed that eGFR ≤ 15 ml/min/1.73 m2 (p = 0.015, Hazard Ratio (HR) = 9.574, 95% CI 4.205–25.187) and ARRS (p = 0.012, HR = 2.115, 95% CI 1.206–4.174) were independent risk factors for ESKD.The area under the curve for ESKD prediction of ARRS was 0.880, and the best cutoff value was 5.50. Delong test result showed that ARRS exhibited better predictive value for ESKD than the Berden classification (p < 0.001) and rapidly progressive glomerulonephritis (p < 0.001). This is the first study to investigate the value of the ARRS for predicting renal prognosis among Chinese children. The ARRS is a preferred index that can predict ESKD in Chinese children with AAGN.

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Validation of the renal risk score for antineutrophil cytoplasmic antibody-associated glomerulonephritis in a Chinese population

Cited by 9 publications

References 26 publications

Evaluation of three scoring systems for predicting renal prognosis in antineutrophil cytoplasmic antibody-associated glomerulonephritis

Evaluation of three scoring systems for predicting renal prognosis in antineutrophil cytoplasmic antibody-associated glomerulonephritis

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

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

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