1
|
Bate S, McGovern D, Costigliolo F, Tan PG, Kratky V, Scott J, Chapman GB, Brown N, Floyd L, Brilland B, Martín-Nares E, Aydın MF, Ilyas D, Butt A, Nic an Riogh E, Kollar M, Lees JS, Yildiz A, Hinojosa-Azaola A, Dhaygude A, Roberts SA, Rosenberg A, Wiech T, Pusey CD, Jones RB, Jayne DR, Bajema I, Jennette JC, Stevens KI, Augusto JF, Mejía-Vilet JM, Dhaun N, McAdoo SP, Tesar V, Little MA, Geetha D, Brix SR. The Improved Kidney Risk Score in ANCA-Associated Vasculitis for Clinical Practice and Trials. J Am Soc Nephrol 2024; 35:335-346. [PMID: 38082490 PMCID: PMC10914211 DOI: 10.1681/asn.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/03/2023] [Indexed: 01/27/2024] Open
Abstract
SIGNIFICANCE STATEMENT Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. More than 1500 patients were collated in an international longitudinal study to revise the ANCA kidney risk score. The score showed satisfactory performance, mimicking the original study (Harrell's C=0.779). In the development cohort of 959 patients, no additional parameters aiding the tool were detected, but replacing the GFR with creatinine identified an additional cutoff. The parameter interstitial fibrosis and tubular atrophy was modified to allow wider access, risk points were reweighted, and a fourth risk group was created, improving predictive ability (C=0.831). In the validation, the new model performed similarly well with excellent calibration and discrimination ( n =480, C=0.821). The revised score optimizes prognostication for clinical practice and trials. BACKGROUND Reliable prediction tools are needed to personalize treatment in ANCA-associated GN. A retrospective international longitudinal cohort was collated to revise the ANCA renal risk score. METHODS The primary end point was ESKD with patients censored at last follow-up. Cox proportional hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell's C statistic, receiver operating characteristics, and calibration plots were used to assess model performance. RESULTS Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per center to development and validation cohorts (52% male, median age 64 years). In the development cohort ( n =959), the ANCA renal risk score was validated and calibrated, and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy allowing semiquantitative reporting. An additional cutoff for kidney function (K) was identified, and serum creatinine replaced GFR (K0: <250 µ mol/L=0, K1: 250-450 µ mol/L=4, K2: >450 µ mol/L=11 points). The risk points for the percentage of normal glomeruli (N) and interstitial fibrosis and tubular atrophy (T) were reweighted (N0: >25%=0, N1: 10%-25%=4, N2: <10%=7, T0: none/mild or <25%=0, T1: ≥ mild-moderate or ≥25%=3 points), and four risk groups created: low (0-4 points), moderate (5-11), high (12-18), and very high (21). Discrimination was C=0.831, and the 3-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination ( n =480, C=0.821). CONCLUSIONS The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
Collapse
Affiliation(s)
- Sebastian Bate
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Dominic McGovern
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Francesca Costigliolo
- Division of Nephrology, Dialysis and Transplantation, University of Genova, Genova, Italy
- Department of Internal Medicine and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Pek Ghe Tan
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Renal Unit, Northern Health, Victoria, Australia
| | - Vojtech Kratky
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Jennifer Scott
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Gavin B. Chapman
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Nina Brown
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | - Lauren Floyd
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, CHU d’Angers, Angers, France
| | - Eduardo Martín-Nares
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Duha Ilyas
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Arslan Butt
- Renal Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, United Kingdom
| | | | - Marek Kollar
- Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Jennifer S. Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Abdülmecit Yildiz
- Division of Nephrology, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Andrea Hinojosa-Azaola
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ajay Dhaygude
- Renal Department, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Stephen A. Roberts
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thorsten Wiech
- University Medical Center Hamburg-Eppendorf, Institute of Pathology, Hamburg, Germany
| | - Charles D. Pusey
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Rachel B. Jones
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David R.W. Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
- Department of Renal Medicine, Vasculitis Clinic, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ingeborg Bajema
- Department of Pathology, Groningen University Medical Center, Groningen, The Netherlands
| | - J. Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kate I. Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | | | - Juan Manuel Mejía-Vilet
- Departments of Immunology and Rheumatology, Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neeraj Dhaun
- University/BHF Centre for Cardiovascular Science, University of Edinburgh and Department of Renal Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Stephen P. McAdoo
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
| | - Vladimir Tesar
- 1st Faculty of Medicine, Charles University, Prague, Czechia
- Department of Nephrology, General University Hospital, Prague, Czechia
| | - Mark A. Little
- Trinity Kidney Centre, Trinity College Dublin, Dublin, Ireland
| | - Duruvu Geetha
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Silke R. Brix
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
2
|
McGovern DP, Lees JS, Traynor JP, Mackinnon B, Bell S, Hunter RW, Dhaun N, Metcalfe W, Kidder D, Lim M, Joss N, Kelly M, Taylor A, Cousland Z, Dey V, Buck K, Brix S, Geddes CC, McQuarrie EP, Stevens KI. Outcomes in ANCA-Associated Vasculitis in Scotland: Validation of the Renal Risk Score in a Complete National Cohort. Kidney Int Rep 2023; 8:1648-1656. [PMID: 37547534 PMCID: PMC10403670 DOI: 10.1016/j.ekir.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) causes autoimmune-mediated inflammation of small blood vessels in multiple organs, including the kidneys. The ability to accurately predict kidney outcomes would enable a more personalized therapeutic approach. Methods We used our national renal biopsy registry to validate the ability of ANCA Renal Risk Score (ARRS) to predict end-stage kidney disease (ESKD) for individual patients. This score uses histopathological and biochemical data to stratify patients as high, medium, or low risk for developing ESKD. Results A total of 288 patients were eligible for inclusion in the study (low risk n = 144, medium risk n = 122, high risk n = 12). Using adjusted Cox proportional hazard models with the low-risk group as reference, we show that outcome differs between the categories: high-risk hazard ratio (HR) 16.69 (2.91-95.81, P = 0.002); medium risk HR 4.14 (1.07-16.01, P = 0.039). Incremental multivariable-adjusted Cox proportional hazards models demonstrated that adding ARRS to a model adjusted for multiple clinical parameters enhanced predictive discrimination (basic model C-statistic 0.864 [95% CI 0.813-0.914], basic model plus ARRS C-statistic 0.877 [95% CI 0.823-0.931]; P <0.01). Conclusion The ARRS better discriminates risk of ESKD in AAV and offers clinicians more prognostic information than the use of standard biochemical and clinical measures alone. This is the first time the ARRS has been validated in a national cohort. The proportion of patients with high-risk scores is lower in our cohort compared to others and should be noted as a limitation of this study.
Collapse
Affiliation(s)
- Dominic P. McGovern
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer S. Lees
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jamie P. Traynor
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Bruce Mackinnon
- Department of Nephrology and Transplantation, John Hunter Hospital, New South Wales, Australia
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Robert W. Hunter
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Dana Kidder
- Renal Unit, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michelle Lim
- Renal Unit, Ninewells Hospital and Medical School, Dundee, UK
| | - Nicola Joss
- Renal Unit, Raigmore Hospital, Inverness, UK
| | - Michael Kelly
- Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | | | | | - Vishal Dey
- Renal Unit, University Hospital Crosshouse, Kilmarnock, UK
| | - Kate Buck
- Renal Unit, Queen Margaret Hospital, Fife Acute Hospitals Trust, Kirkcaldy, Fife, UK
| | - Silke Brix
- Renal, Urology and Transplantation Unit, Manchester University Hospitals, Manchester, UK
- Cardiovascular Science, University of Manchester, Manchester, UK
| | - Colin C. Geddes
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emily P. McQuarrie
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Kathryn I. Stevens
- Glasgow Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
3
|
Wang RX, Wang JW, Li ZY, Chen SF, Yu XJ, Wang SX, Zhang F, Xiong ZY, Bi SH, Wang Y, Zhao MH, Chen M. A modified renal risk score for Chinese patients with antineutrophil cytoplasmic antibody-associated vasculitis. BMC Med 2023; 21:45. [PMID: 36755282 PMCID: PMC9909876 DOI: 10.1186/s12916-023-02755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Rui-Xue Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Jin-Wei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Zhi-Ying Li
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.
| | - Su-Fang Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Xiao-Juan Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| | - Su-Xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.,Laboratory of Electron Microscopy, Pathological Centre, Peking University First Hospital, Beijing, 100034, China
| | - Fan Zhang
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Zu-Ying Xiong
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Shenzhen, 518036, China.,Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen, 518036, China
| | - Shu-Hong Bi
- Division of Nephrology, Peking University Third Hospital, Beijing, 100191, China
| | - Yue Wang
- Division of Nephrology, Peking University Third Hospital, Beijing, 100191, China
| | - Ming-Hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100034, China
| | - Min Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, 100034, China
| |
Collapse
|
4
|
Uchida T, Ichinose K, Yamashita A, Muta K, Kitamura M, Sato S, Iwamoto N, Nishino T, Kawakami A. Evaluation of a renal risk score for Japanese patients with ANCA-associated glomerulonephritis in a multi-center cohort study. Front Immunol 2023; 14:1141407. [PMID: 36926340 PMCID: PMC10011144 DOI: 10.3389/fimmu.2023.1141407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background In patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, prediction of renal survival should guide the choice of therapy, but a prediction of the histological classification has inconsistencies. Objectives To evaluate the usefulness of renal risk score (RRS) for Japanese patients with ANCA-associated glomerulonephritis (AAGN) and compare the prediction for end-stage renal disease (ESRD) between RRS and the histological classification. Methods We retrospectively analyzed 96 patients with AAGN who underwent a renal biopsy. Renal survival was categorized by RRS, and the histological classification was assessed separately. We compared the predictive values for RRS and the histological classification. Results The median observational period was 37.5 (interquartile range [IQR] 21.5-77.0) months. The median RRS point at the time of renal biopsy was 2 (IQR 0-7.8), and the patients were categorized into low- (n = 29), medium- (n = 43), and high-risk groups (n = 24) using RRS. As expected, the renal prognosis was the worst in the "high-risk" group and the best in the "low-risk" group. In the histological classification, the survival deteriorated progressively from "focal" (best) to "mixed," "crescentic," and "sclerotic" (worst) classes, different from the order in the original proposal for this system. Multivariable Cox regression analysis revealed that RRS was independently associated with ESRD. The difference in prediction for renal survival between RRS and the histological classification was not significant using area under receiver-operating-characteristic curves. Conclusion We evaluated the usefulness of RRS in Japanese patients with AAGN and found it a stable predictor of renal survival in such patients.
Collapse
Affiliation(s)
- Tomohisa Uchida
- Department of Rheumatology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan.,Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Ayuko Yamashita
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
5
|
Wu L, Wang G, Yang B, Liu X, Xie C, Feng X, Jin L, Zhou Z, Yang M, Zhou Z, Su C, Li Y, Song Y, Cao W. Urinary Matrix Metalloproteinase 7 Activated by Oxidative Stress Predicts Kidney Prognosis in Myeloperoxidase-Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Antioxid Redox Signal 2022; 37:246-256. [PMID: 35152729 DOI: 10.1089/ars.2021.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aims: Effective and applicable predictors of end-stage kidney disease (ESKD) are needed for patients with myeloperoxidase-antineutrophil cytoplasmic antibody-associated vasculitis (MPO-AAV) and kidney involvement. We investigated whether urinary matrix metalloproteinase-7 (uMMP7) was associated with kidney injury severity and incident ESKD in MPO-AAV. Results: A prospective two-stage study was conducted in 150 patients with newly diagnosed MPO-AAV in two independent cohorts. uMMP7 was measured on the days of initial and repeat kidney biopsies. In stage I, a higher initial uMMP7 level was associated with a lower estimated glomerular filtration rate (eGFR), higher level of proteinuria, and greater extent of kidney pathologic lesions. This elevated uMMP7 protein level is activated and potentially derived from the enhanced kidney production induced by oxidative stress. In stage II, uMMP7 at initial biopsy was independently associated with the incidence of ESKD over 6 years. The higher uMMP7 group (vs. lower) had an adjusted hazard ratio of 3.79 (95% confidence interval [CI], 1.49-6.09) for ESKD in the test cohort. Findings were similar in the validation cohort. A combination of data from the two cohorts revealed that adding uMMP7 into clinical or clinicopathologic models significantly improved risk discrimination for future ESKD. Innovation: An elevated uMMP7 level in MPO-AAV was independently associated with severe kidney injury and incident ESKD. Conclusions: uMMP7 in MPO-AAV improves identification of patients at risk of ESKD and may enable early and optimized therapy to improve outcomes. Antioxid. Redox Signal. 37, 246-256.
Collapse
Affiliation(s)
- Liling Wu
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China.,Division of Nephrology, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, P.R. China
| | - Guobao Wang
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Bihui Yang
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Xiaoting Liu
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Chao Xie
- Division of Nephrology, The First People's Hospital of Foshan, Foshan, P.R. China
| | - Xiaodan Feng
- Division of Nephrology, Guangzhou Development District Hospital, Guangzhou, P.R. China
| | - LinWei Jin
- Division of Nephrology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, P.R. China
| | - Zhuoyu Zhou
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Manqiu Yang
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Zhanmei Zhou
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Cailing Su
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Yajing Li
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| | - Yali Song
- Center for Reproductive Medicine, Dongguan Maternal and Child Health Care Hospital, Southern Medical University, Dongguan, P.R. China
| | - Wei Cao
- State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, P.R. China
| |
Collapse
|
6
|
Histopathological prognostic factors in ANCA-associated glomerulonephritis. Autoimmun Rev 2022; 21:103139. [PMID: 35835443 DOI: 10.1016/j.autrev.2022.103139] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are a group of multisystemic autoimmune diseases characterized by necrotizing inflammation of small vessels. Kidney involvement is frequent in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), and accounts for a significant proportion of the morbidity and mortality related to these diseases. Despite improvement in therapeutic management of ANCA-glomerulonephritis (ANCA-GN), end-stage kidney disease (ESKD) still occurs in up to 30% of affected patients within 5 years following diagnosis. Thus, identifying patients for whom aggressive immunosuppressive therapy will be more beneficial than deleterious is of great importance. Several clinical, biological and histological factors have been proposed as predictors of ESKD. The kidney biopsy is essential not only for the diagnosis, but also for evaluating renal prognosis. In this review, we discuss the prognostic value of renal lesions at the diagnosis of ANCA-GN by analyzing each compartment of the nephron. We also review existing ESKD risk classification in ANCA-GN and finally propose an example of a standardized pathology report that could be used in routine practice.
Collapse
|
7
|
Brilland B, Boud'hors C, Copin MC, Jourdain P, Henry N, Wacrenier S, Djema A, Samoreau C, Coindre JP, Cousin M, Riou J, Croue A, Saint-André JP, Subra JF, Piccoli GB, Augusto JF. 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. Front Immunol 2022; 13:834878. [PMID: 35392077 PMCID: PMC8981524 DOI: 10.3389/fimmu.2022.834878] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The “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 Methods We 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. Results The 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). Conclusion The 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.
Collapse
Affiliation(s)
- Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Charlotte Boud'hors
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Marie-Christine Copin
- Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France.,Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse, CH de Laval, Laval, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Service de Néphrologie-Dialyse, CH du Mans, Le Mans, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, CH de Cholet, Cholet, France
| | - Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | | | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jeremie Riou
- Micro et Nanomedecines Translationnelles, MINT, Université d'Angers, Unité Mixte de Recherche (UMR) Institut National de la Santé Et de la Recherche Médicale (INSERM) 6021, Unité Mixte de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 6021, Angers, France.,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Anne Croue
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-Paul Saint-André
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | | | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| |
Collapse
|
8
|
Xia M, Yu R, Zheng Z, Li H, Feng J, Xie X, Chen D. Meta-Analytical Accuracy of ANCA Renal Risk Score for Prediction of Renal Outcome in Patients With ANCA-Associated Glomerulonephritis. Front Med (Lausanne) 2022; 8:736754. [PMID: 35071256 PMCID: PMC8770957 DOI: 10.3389/fmed.2021.736754] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background: To evaluate the diagnostic accuracy of antineutrophil cytoplasmic antibody (ANCA) renal risk score (ARRS) for prediction of renal outcome in patients with ANCA-associated glomerulonephritis (ANCA-GN). Methods: We searched PubMed, EMBASE, Ovid, Web of Science, the Cochrane Library, and ClinicalTrials.gov for studies, which used ARRS to predict end-stage renal disease (ESRD) in patients with ANCA-GN. Two reviewers independently screened articles for inclusion, assessed the quality of studies with both an adapted Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. We calculated the combined patients with ESRD in the ARRS categories and presented the summary and individual estimates based on the ARRS categories. Then, the sensitivity, specificity, diagnostic odds ratio (DOR), positive/negative likelihood ratio, and the area under the receiver operating characteristic (AUROC) curves of the pooled data for ARRS were used to assess the accuracy of the “above the low-risk threshold” (ARRS ≥ 2) and “high-risk grade” (ARRS ≥ 8) for renal outcome of patients with ANCA-GN. The hierarchical summary ROC (HSROC) was used to verify the accuracy value. The clinical utility of ARRS was evaluated by the Fagan plot. Heterogeneity was explored using meta-regression and subgroup analysis. Results: A total of 12 distinct cohorts from 11 articles involving 1,568 patients with ANCA-GN were analyzed. The cumulative patients with ESRD at the maximum follow-up of 60 months was 5% (95% CI: 0.02–0.07; p < 0.001) for ANCA-GN with low ARRS (0–1 points) and significantly increased to 22% (95% CI: 0.15–0.29; p < 0.001) medium ARRS (2–7 points). The combined cumulative patients with ESRD was 59% (95% CI: 0.49–0.69; p < 0.001) high ARRS (8–11 points). The pooled sensitivity of ARRS ≥ 2 in predicting ESRD was 98% with a specificity of 30% and a DOR of 15.08 and the mean AUROC value was 0.82. The pooled sensitivity of ARRS ≥ 8 in predicting ESRD was 58% with a specificity of 86% and a DOR of 7.59. The meta-regression and subgroup analysis indicated that variation in the geographic regions, study design, index risk, follow-up time, age of patient, publication year, and number of patient could be the potential sources of heterogeneity in the diagnosis of ARRS ≥ 8. Conclusion: This meta-analysis emphasized the good performance of the ARRS score in predicting the renal outcome in patients with ANCA-GN. However, these findings should be verified by future large-scale prospective studies.
Collapse
Affiliation(s)
- Mengdi Xia
- Nanchong Key Laboratory of Basic Science and Clinical Research on Chronic Kidney Disease, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China
| | - Ruiran Yu
- Department of Oncology, Anqing First People's Hospital of Anhui Medical University, Anqing, China
| | - Zaiqiong Zheng
- Nanchong Key Laboratory of Basic Science and Clinical Research on Chronic Kidney Disease, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China
| | - Huan Li
- Nanchong Key Laboratory of Basic Science and Clinical Research on Chronic Kidney Disease, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China
| | - Jie Feng
- Nanchong Key Laboratory of Basic Science and Clinical Research on Chronic Kidney Disease, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China
| | - Xisheng Xie
- Nanchong Key Laboratory of Basic Science and Clinical Research on Chronic Kidney Disease, Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital), Nanchong, China
| | - Dongming Chen
- Department of Neurosurgery, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
| |
Collapse
|
9
|
Boudhabhay I, Delestre F, Coutance G, Gnemmi V, Quemeneur T, Vandenbussche C, Lazareth H, Canaud G, Tricot L, Gosset C, Hummel A, Terrier B, Rabant M, van Daalen EE, Wester Trejo MA, Bajema IM, Karras A, Duong Van Huyen JP. Reappraisal of Renal Arteritis in ANCA-associated Vasculitis: Clinical Characteristics, Pathology, and Outcome. J Am Soc Nephrol 2021; 32:2362-2374. [PMID: 34155059 PMCID: PMC8729836 DOI: 10.1681/asn.2020071074] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 05/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Renal involvement in ANCA-associated vasculitis (AAV) is associated with poor outcomes. The clinical significance of arteritis of the small kidney arteries has not been evaluated in detail. METHODS In a multicenter cohort of patients with AAV and renal involvement, we sought to describe the clinicopathologic characteristics of patients with AAV who had renal arteritis at diagnosis, and to retrospectively analyze their prognostic value. RESULTS We included 251 patients diagnosed with AAV and renal involvement between 2000 and 2019, including 34 patients (13.5%) with arteritis. Patients with AAV-associated arteritis were older, and had a more pronounced inflammatory syndrome compared with patients without arteritis; they also had significantly lower renal survival (P=0.01). In multivariable analysis, the ANCA renal risk score, age at diagnosis, history of diabetes mellitus, and arteritis on index kidney biopsy were independently associated with ESKD. The addition of the arteritis status significantly improved the discrimination of the ANCA renal risk score, with a concordance index (C-index) of 0.77 for the ANCA renal risk score alone, versus a C-index of 0.80 for the ANCA renal risk score plus arteritis status (P=0.008); ESKD-free survival was significantly worse for patients with an arteritis involving small arteries who were classified as having low or moderate risk, according to the ANCA renal risk score. In two external validation cohorts, we confirmed the incidence and phenotype of this AAV subtype. CONCLUSIONS Our findings suggest AAV with renal arteritis represents a different subtype of AAV with specific clinical and histologic characteristics. The prognostic contribution of the arteritis status remains to be prospectively confirmed.
Collapse
Affiliation(s)
- Idris Boudhabhay
- Department of Pathology, Necker Hospital, Paris, France,Department of Nephrology and Transplantation, Necker Hospital, Paris, France,Paris University, Paris, France
| | - Florence Delestre
- Paris University, Paris, France,Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Paris, France
| | - Guillaume Coutance
- Paris-Sorbonne University, Paris, France,Department of Cardiac and Thoracic Surgery, Cardiology Institute, Paris, France
| | - Viviane Gnemmi
- Pathology Department, Lille University Hospital, Lille, France,JPARC-Jean-Pierre Aubert Research Center, Lille, France
| | - Thomas Quemeneur
- Nephrology and Internal Medicine Department, Hospital of Valenciennes, Valenciennes, France
| | - Cyrille Vandenbussche
- Nephrology and Internal Medicine Department, Hospital of Valenciennes, Valenciennes, France
| | - Helene Lazareth
- Renal Division, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | - Guillaume Canaud
- Department of Nephrology and Transplantation, Necker Hospital, Paris, France,Paris University, Paris, France
| | - Leila Tricot
- Department of Nephrology, Hôpital Foch, Suresnes, France
| | - Clément Gosset
- Department of Nephrology, Centre Universitaire de la Réunion, La Réunion, France
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Necker Hospital, Paris, France
| | - Benjamin Terrier
- Paris University, Paris, France,Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Paris, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Paris, France
| | - Emma E. van Daalen
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ingeborg M. Bajema
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexandre Karras
- Renal Division, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, and Université de Paris, Paris, France
| | | |
Collapse
|
10
|
Bai X, Guo Q, Lou Y, Nie P, Zhu Y, Li B, Luo P. Validation of the renal risk score for antineutrophil cytoplasmic antibody-associated glomerulonephritis in a Chinese population. Clin Rheumatol 2021; 40:5009-5017. [PMID: 34282511 DOI: 10.1007/s10067-021-05862-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In 2018, a renal risk score of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) based on estimated glomerular filtration rate (eGFR), normal glomeruli, and tubular atrophy/interstitial fibrosis (TA/IF) was proposed to predict renal outcomes. We aimed to evaluate this renal risk score in a myeloperoxidase (MPO)-ANCA predominant population in Northeast China. METHODS We retrospectively analyzed the clinicopathologic data of 65 patients biopsy-proven from a Chinese medical center. Each patient was assessed by eGFR, normal glomeruli, and TA/IF, and the renal outcome was evaluated using the renal risk score. RESULTS In our study, 95.4% of patients were ANCA positive (78.5% MPO-ANCA positive and 16.9% proteinase 3-ANCA positive). The average follow-up period was 14.3 months. Thirty-four patients (52.3%) reached end-stage renal disease (ESRD). Based on the renal risk score, 8 (12.3%), 31 (47.7%), and 26 (40%) patients were divided into the low-risk, medium-risk, and high-risk groups, respectively. Kaplan-Meier survival curves revealed the high-risk group had worse renal outcomes than the low-risk group (p<0.01) and the medium-risk group (p<0.01), but the renal outcome did not differ between the low-risk and medium-risk groups (p>0.017). Similar results were obtained by the competitive survival analysis. The AUC for 3-year overall ESRD predictions was 0.845. In the regression analysis, the renal risk score was a favorable predictor for the development of ESRD (HR 3.13, 95%CI 1.58-6.19, p=0.001). CONCLUSION The renal risk score is a preferred index that can predict ESRD in Chinese AAGN patients, especially in the high-risk group with worse renal outcomes. Key Points • The eGFR and percentage of normal glomeruli were valuable predictors of renal outcome, whereas TA/IF was not. • We confirmed the renal risk score is a preferred index that can predict ESRD in Chinese AAGN patients. • Based on the renal risk score, the high-risk group had worse renal outcomes than the low-risk group and the medium-risk group.
Collapse
Affiliation(s)
- Xue Bai
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Qiaoyan Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Yan Lou
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Ping Nie
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Yuexin Zhu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Bing Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China.
| | - Ping Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China.
| |
Collapse
|
11
|
Huang X, Chen L, Lan L, Ren P, Ni A, Ma Y, Wang Y, Zhu Y, Xu Y, Chen J, Han F. Antineutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Kidney Injury: Short-Term Recovery Predicts Long-Term Outcome. Front Immunol 2021; 12:641655. [PMID: 34305886 PMCID: PMC8299708 DOI: 10.3389/fimmu.2021.641655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Kidney 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. Methods Patients 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. Results Of 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. Conclusion KDIGO 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.
Collapse
Affiliation(s)
- Xiaohan Huang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Liangliang Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Lan Lan
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Pingping Ren
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Anqi Ni
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Yanhong Ma
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Yaomin Wang
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Yilin Zhu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Ying Xu
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Institute of Nephrology, Zhejiang University, Hangzhou, China.,Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, China
| |
Collapse
|
12
|
Lim JH, Han MH, Kim YJ, Jeon Y, Jung HY, Choi JY, Cho JH, Kim CD, Kim YL, Lee H, Kim DK, Moon KC, Park SH. Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort. Kidney Res Clin Pract 2021; 40:77-88. [PMID: 33789384 PMCID: PMC8041633 DOI: 10.23876/j.krcp.20.184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/22/2020] [Indexed: 12/15/2022] Open
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 ESKD despite treatment.
Collapse
Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Man-Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Jin Kim
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Republic of Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Ji-Young Choi
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University School of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Hee Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
13
|
Brix SR, Stahl RAK, Wiech T. The authors reply. Kidney Int 2021; 99:489-490. [PMID: 33509361 DOI: 10.1016/j.kint.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Silke R Brix
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK; Renal Department, Manchester University Hospital, Manchester, UK.
| | - Rolf A K Stahl
- III. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Wiech
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
14
|
Brix SR, Geetha D. Keeping Up with the Times. Clin J Am Soc Nephrol 2020; 15:1078-1080. [PMID: 32723806 PMCID: PMC7409759 DOI: 10.2215/cjn.09600620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Silke R. Brix
- Division of Cardiovascular Science, University of Manchester, Manchester, United Kingdom
- Renal, Transplantation and Urology Unit, Manchester Royal Infirmary, Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Duvuru Geetha
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
15
|
Solmaz D, Akar S. Response to: 'Bowman's capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications' by L'Imperio et al. Ann Rheum Dis 2020; 81:e96. [PMID: 32532748 DOI: 10.1136/annrheumdis-2020-218035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Dilek Solmaz
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi Universitesi Tip Fakultesi, Izmir, Turkey
| | - Servet Akar
- Division of Rheumatology, Department of Internal Medicine, Izmir Katip Celebi Universitesi Tip Fakultesi, Izmir, Turkey
| |
Collapse
|
16
|
L'Imperio V, Vischini G, Pagni F, Ferraro PM. Bowman's capsule rupture on renal biopsy improves the outcome prediction of ANCA-associated glomerulonephritis classifications. Ann Rheum Dis 2020; 81:e95. [PMID: 32532749 DOI: 10.1136/annrheumdis-2020-217979] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Vincenzo L'Imperio
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Gisella Vischini
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| |
Collapse
|