The Value of the Current Histological Scores and Classifications of ANCA Glomerulonephritis in Predicting Long-term Outcome

Overview

Journal Clin Kidney J

Publisher Oxford University Press

Specialty Nephrology

Date 2024 Jul 4

PMID 38962252

Authors

Matteo Stella

Laura Locatelli

Filippo Maria Sala

Francesco Reggiani

Marta Calatroni

Vincenzo LImperio

Fabio Pagni

Umberto Maggiore

Gabriella Moroni

Renato Alberto Sinico

Affiliations

Soon will be listed here.

Abstract

Background: Three different histological scores-histopathologic classification (Berden), Renal Risk Score (RRS) and the Mayo Clinic Chronicity Score (MCCS)-for anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) were compared to evaluate their association with patient and kidney prognosis of ANCA-GN.

Methods: Patients aged >18 years with at least 1 year of follow-up and biopsy-proven ANCA-GN entered this retrospective study. Renal biopsies were classified according to Berden's classification, RRS and MCCS. The first endpoint was end-stage kidney disease (ESKD), defined as chronic dialysis or estimated glomerular filtration rate <15 mL/min/1.73 m. The second endpoint was ESKD or death.

Results: Of 152 patients 84 were males, with median age of 63.8 years and followed for 46.9 (interquartile range 12.8-119) months, 59 (38.8%) reached the first endpoint and 20 died. The Kaplan-Meier curves showed that Berden and RRS were associated with first (Berden: = .004, RRS: < .001) and second (Berden: = .001, RRS: < .001) endpoint, MCCS with the first endpoint only when minimal + mild vs moderate + severe groups were compared ( = .017), and with the second endpoint ( < .001). Among the clinical/histological presentation features, arterial hypertension [odds ratio (OR) = 2.75, confidence interval (95% CI) 1.50-5.06; = .0011], serum creatinine (OR = 1.17, 95% CI 1.09-1.25; < .0001), and the percentage of normal glomeruli (OR = 0.97, 95% CI 0.96-0.99; = .009) were the independent predictors of ESKD at multivariate analysis. When the three scores were included in multivariate analysis, RRS (OR = 2.21, 95% CI 1.15-4.24; = .017) and MCCS (OR = 2.03, 95% CI 1.04-3.95; = .037) remained predictive of ESKD, but Berden (OR = 1.17, 95% CI 0.62-2.22; = .691) did not.

Conclusion: RRS and MCCS scores were independent predictors of kidney survival together with high serum creatinine and arterial hypertension at diagnosis, while Berden classification was not.

Citing Articles

ANCA renal risk score to predict kidney outcomes in an Australian cohort: a single-centre experience.

Paxton L, Schembri E, Hunt B, Longano A, McMahon L, Wong L J Nephrol. 2025; .

PMID: 40088350 DOI: 10.1007/s40620-025-02276-8.

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