Tubulointerstitial damage and interstitial immune cell phenotypes are useful predictors for renal survival and relapse in antineutrophil cytoplasmic antibody-associated vasculitis
| Autor: | Nicolas Wayolle, Marie Frimat, Claude-Alain Maurage, François Glowacki, Philippe Vanhille, Jean-Baptiste Gibier, Jérôme Verine, Cyrille Vandenbussche, Sarah Humez, Nassima Ramdane, Carole Cordonnier, Thomas Quemeneur, Pierre-Yves Hatron, Laura Bitton, Evelyne Mac Namara, Pierre Bataille, David Buob, Raymond Azar, Marie-Christine Copin, Viviane Gnemmi, Rémi Lenain, Michael Perrais |
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| Rok vydání: | 2019 |
| Předmět: |
Nephrology
medicine.medical_specialty 030232 urology & nephrology Renal function Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis 030204 cardiovascular system & hematology Kidney Gastroenterology End stage renal disease Antibodies Antineutrophil Cytoplasmic 03 medical and health sciences 0302 clinical medicine Recurrence Internal medicine Biopsy Medicine Humans Anti-neutrophil cytoplasmic antibody Retrospective Studies CD20 medicine.diagnostic_test biology business.industry medicine.disease medicine.anatomical_structure Kidney Tubules Phenotype biology.protein Kidney Failure Chronic business Vasculitis |
| Zdroj: | Journal of nephrology. 33(4) |
| ISSN: | 1724-6059 |
| Popis: | The aims of this study were to determine whether tubulointerstitial damage in the form of interstitial fibrosis/tubular atrophy and total interstitial inflammation predicted progression to end stage renal disease (ESRD) and/or renal relapse (RR) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). One hundred thirteen patients with AAV from six French centers with an index biopsy performed between 2003 and 2013 were included. Histological assessments using the AAV glomerular classification and the kidney allograft Banff classification were performed on pathological review. Biopsy tissues were also investigated by CD3, CD20, CD68, CD163, FOXP3 and RORγt immunohistochemical staining. Competing risks models were calculated. Of the 113 patients, 26 (23.0%) died during follow-up and 29 (25.6%) developed ESRD. Among the 94 patients who achieved remission by the end of induction therapy without developing ESRD, 26 (27.6%) experienced RR. The two independent prognostic factors for ESRD were the estimated glomerular filtration rate at presentation (HR 0.35; 95% CI 0.23-0.51; P 0.0001) and IF/TA 25% (HR 2.27; 95% CI 1.18-4.37; P = 0.014). When the distribution of interstitial immune cell phenotypes was included in a second multivariable model, the organization of lymphocytic infiltrates was also an independent predictor of ESRD (HR 2.86; 95% CI 1.35-6.1, P = 0.006). The independent risk factors for RR were a higher CD3/CD20 ratio (HR 1.39; 95% CI 1.05-1.85; P = 0.02) and the presence of RORγt positive cells (HR 2.70; 95% CI 1.11-6.54; P = 0.02). Our results highlight the prognostic value of initial histological evaluations in AAV. Measurements of tubulointerstitial damage and interstitial immune cell phenotype distributions should be considered to improve risk assessments for ESRD and RR. |
| Databáze: | OpenAIRE |
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