Kidney Res Clin Pract.  2021 Mar;40(1):77-88. 10.23876/j.krcp.20.184.

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

Affiliations
  • 1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
  • 2Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
  • 3Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
  • 4Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
  • 5Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
  • 6Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Republic of Korea
  • 7Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  • 8Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea

Abstract

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.
Conclusion
In Korean AAGN patients, histopathologic and clinicopathologic classifications had predictive value for renal outcomes, especially in the sclerotic class or the high-risk group with higher risk of progression to ESRD despite treatment.

Keyword

Antineutrophil cytoplasmic antibody-associated glomerulonephritis; Clinicopathologic classification; End-stage kidney disease; Histopathologic classification
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