Developments in the Histopathological Classification of ANCA-Associated Glomerulonephritis.

Autor:	van Daalen EE; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Wester Trejo MAC; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Göçeroğlu A; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Ferrario F; Nephropathology Center, San Gerardo Hospital, Monza, Italy., Joh K; Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan., Noël LH; Department of Pathology, Necker Hospital, René Descartes University, Paris, France., Ogawa Y; Hokkaido Renal Pathology Center, Sapporo, Japan., Wilhelmus S; Pathology Laboratory Pathan, Rotterdam, The Netherlands., Ball MJ; Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Honsova E; Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic., Hruskova Z; Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic., Kain R; Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Kimura T; Department of Nephrology, Japan Community Healthcare Organization, Sendai Hospital, Sendai, Japan., Kollar M; Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic., Kronbichler A; Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria., Lindhard K; Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Puéchal X; Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France., Salvatore S; Department of Pathology, Weill Cornell Medical College, New York, New York., Szpirt W; Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark., Takizawa H; Department of Nephrology, Teine Keijinkai Hospital, Sapporo, Japan., Tesar V; Department of Nephrology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic., Berden AE; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Dekkers OM; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands., Hagen EC; Department of Nephrology, Meander Medical Center, Amersfoort, The Netherlands., Oosting J; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Rahmattulla C; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Wolterbeek R; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands., Bos WJ; Department of Internal Medicine, St. Antoniusziekenhuis, Nieuwegein, The Netherlands.; Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands., Bruijn JA; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands., Bajema IM; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2020 Aug 07; Vol. 15 (8), pp. 1103-1111. Date of Electronic Publication: 2020 Jul 28.
DOI:	10.2215/CJN.14561119
Abstrakt:	Background and Objectives: The histopathologic classification for ANCA-associated GN distinguishes four classes on the basis of patterns of injury. In the original validation study, these classes were ordered by severity of kidney function loss as follows: focal, crescentic, mixed, and sclerotic. Subsequent validation studies disagreed on outcomes in the crescentic and mixed classes. This study, driven by the original investigators, provides several analyses in order to determine the current position of the histopathologic classification of ANCA-associated GN. Design, Setting, Participants, & Measurements: A validation study was performed with newly collected data from 145 patients from ten centers worldwide, including an analysis of interobserver agreement on the histopathologic evaluation of the kidney biopsies. This study also included a meta-analysis on previous validation studies and a validation of the recently proposed ANCA kidney risk score. Results: The validation study showed that kidney failure at 10-year follow-up was significantly different between the histopathologic classes ( P <0.001). Kidney failure at 10-year follow-up was 14% in the crescentic class versus 20% in the mixed class ( P =0.98). In the meta-analysis, no significant difference in kidney failure was also observed when crescentic class was compared with mixed class (relative risk, 1.15; 95% confidence interval, 0.94 to 1.41). When we applied the ANCA kidney risk score to our cohort, kidney survival at 3 years was 100%, 96%, and 77% in the low-, medium-, and high-risk groups, respectively ( P <0.001). These survival percentages are higher compared with the percentages in the original study. Conclusions: The crescentic and mixed classes seem to have a similar prognosis, also after adjusting for differences in patient populations, treatment, and interobserver agreement. However, at this stage, we are not inclined to merge the crescentic and mixed classes because the reported confidence intervals do not exclude important differences in prognosis and because an important histopathologic distinction would be lost. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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