Kidney Biopsy Chronicity Grading in Antineutrophil Cytoplasmic Antibody-associated Vasculitis

Overview

Journal Nephrol Dial Transplant

Publisher Oxford University Press

Specialties General Surgery
Nephrology

Date 2021 Aug 26

PMID 34436585

Citations 19

Authors

Marta Casal Moura

Fernando C Fervenza

Ulrich Specks

Sanjeev Sethi

Affiliations

Soon will be listed here.

Abstract

Background: Kidney biopsy is valuable for prognostic assessment of renal outcomes in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with glomerulonephritis (AAV-GN) but the impact of chronic changes is not determined.

Methods: We conducted a retrospective cohort study of myeloperoxidase (MPO)- or proteinase 3 (PR3)-ANCA-positive patients with AAV and active renal disease. We applied the Mayo Clinic Chronicity Score (MCCS) and validated and evaluated its implications on outcome prediction in AAV-GN.

Results: We analyzed 329 patients with kidney biopsies available to score. The extent of chronicity was graded by MCCS as minimal [102 (31.0%)], mild [106 (32.2%)], moderate [86 (26.1%)] and severe [35 (10.6%)]. The MCCS grades correlated with the degree of renal function impairment at presentation [mean estimated glomerular filtration rate (eGFR) 48.3 versus 29.2 versus 23.7 versus 18.5 mL/min/1.73 m2, respectively; P < 0.0001]. Higher degrees of the individual components of the MCCS (glomerulosclerosis, interstitial fibrosis, tubular atrophy and arteriosclerosis) were associated with lower median eGFR (P < 0.0001) and decreased event-free [kidney failure (KF) and death] survival (P = 0.002, P < 0.0001, P < 0.0001 and P = 0.017, respectively). Patients with lower MCCS grades recovered renal function more frequently (P < 0.0001). Increasing MCCS grades were associated with decreased renal recovery (P = 0.001), more frequent events and shorter time to KF (P < 0.0001), KF and death (P < 0.0001) and death (P = 0.042), independent of the remission induction treatment used (cyclophosphamide or rituximab). The MCCS stratified renal outcomes for each MCCS grade and can be used in clinical practice as a cutoff for KF prediction (MCCS ≥4).

Conclusions: Chronic changes on kidney histology independently predict renal function, outcomes and response to treatment in AAV-GN.

Citing Articles

ANCA-Associated Glomerulonephritis: Diagnosis and Therapy Proceedings of the Henry Shavelle Lectureship.

Ivkovic V, Windpessl M, Berke I, Geetha D, Callemeyn J, Norouzi S Glomerular Dis. 2025; 5(1):26-47.

PMID: 39991195 PMC: 11842095. DOI: 10.1159/000542925.

"Normal" Glomerular Score Correlates With Outcomes in Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis With Glomerulonephritis.

Casal Moura M, Fervenza F, Specks U, Sethi S Kidney Int Rep. 2025; 10(2):596-600.

PMID: 39990903 PMC: 11843102. DOI: 10.1016/j.ekir.2024.11.019.

Urine epidermal growth factor as a biomarker for kidney function recovery and prognosis in glomerulonephritis with severe kidney function impairment.

Hernandez-Andrade A, Nordmann-Gomes A, Juarez-Cuevas B, Zavala-Miranda M, Cruz C, Mejia-Vilet J J Nephrol. 2024; 37(8):2243-2253.

PMID: 39367213 DOI: 10.1007/s40620-024-02068-6.

The value of the current histological scores and classifications of ANCA glomerulonephritis in predicting long-term outcome.

Stella M, Locatelli L, Sala F, Reggiani F, Calatroni M, LImperio V Clin Kidney J. 2024; 17(7):sfae125.

PMID: 38962252 PMC: 11217817. DOI: 10.1093/ckj/sfae125.

[Renal involvement in systemic diseases].

Kain R Pathologie (Heidelb). 2024; 45(4):261-268.

PMID: 38805092 PMC: 11199298. DOI: 10.1007/s00292-024-01338-1.

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