The global glomerulitis score could be a predictor of end-stage kidney disease (ESKD) in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with glomerulonephritis (AAV-GN), according to a preprint posted in Research Square.
“This study is the first to show that global glomerulitis independently predicted the progression to ESKD in Korean patients with AAV-GN. Therefore, more careful monitoring and shorter follow-ups are needed in patients with AAV-GN with high global glomerulitis scores in the biopsy findings,” the study’s authors concluded.
Multivariate analysis of clinical and histopathological features showed that high global glomerulitis scores, serum creatinine, and serum blood urea nitrogen levels were independently and significantly associated with progression to ESKD.
Patients assigned to the sclerotic histopathological class, which was more frequently observed among those with ESKD, had the worst renal prognosis of the 4 histopathological classes (ie, focal, crescentic, mixed, and sclerotic). On the other hand, patients assigned to the focal class showed a higher cumulative ESKD-free survival rate than those in the crescentic and in the sclerotic classes.
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The proportion of patients with global glomerular sclerosis was higher among those with ESKD. Moreover, patients with ESKD scored “high” more frequently in interstitial fibrosis, tubular atrophy, and global glomerulitis. Patients scoring high on these 3 items showed lower cumulative ESKD-free survival rates compared to those scoring low.
The study found that patients with ESKD had larger amounts of proteinuria and higher levels of serum blood urea nitrogen, creatinine, and uric acid. Conversely, the levels of hemoglobin, C-reactive protein, and C3 complement, and the estimated glomerular filtration rate were lower in patients with ESKD compared to patients without ESKD.
The study enrolled 113 Korean patients (median age at diagnosis, 59.0 years, 33.6% male) diagnosed with AAV with glomerulonephritis as confirmed by kidney biopsy.
Sung-Eun Choi, Soo Bin Lee, Jung Yoon Pyo et al. Renal histopathological indices for predicting the progression to end-stage kidney disease in patients with antineutrophil cytoplasmic antibody-associated vasculitis and glomerulonephritis: a single-centre study in Korea. Res Sq. Posted February 13, 2023. doi:10.21203/rs.3.rs-2563281/v1]