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Prognosis and Histological Classification in Elderly Patients with ANCA-Glomerulonephritis: A Registry-Based Cohort

Rune Bjørneklett1,2, Leif Bostad3, Anne-Siri Fismen4

  • 1Department of Clinical Medicine, University of Bergen, Jonas Lies vei 91b, 5021 Bergen, Norway.

Biomed Research International
|June 30, 2018
PubMed

Insights

Histological classification of anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN) helps predict end-stage renal disease (ESRD) risk in elderly patients. However, it does not predict overall patient survival in this age group.

Area of Science:

  • Nephrology
  • Immunology
  • Pathology

Background:

  • Histological classification is established for predicting end-stage renal disease (ESRD) in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN).
  • Prognostic value of ANCA-GN histological subtypes in elderly patients (≥70 years) remains uninvestigated.

Purpose of the Study:

  • To evaluate the prognostic utility of histological classification in elderly patients diagnosed with ANCA-GN.
  • To assess the association between ANCA-GN histological subtypes and ESRD risk or patient survival in older adults.

Main Methods:

  • Retrospective analysis of 81 elderly patients (≥70 years) with biopsy-verified pauci-immune necrotizing glomerulonephritis and positive ANCA serology.
  • Inclusion criteria from the Norwegian Kidney Biopsy Registry (1991-2012).
  • ESRD and mortality data obtained via linkage with national registries; comparison of ESRD-free and patient survival across four histological types (focal, mixed, crescentic, sclerotic).

Main Results:

  • Significant variation in 1-year and 5-year ESRD-free survival across histological groups (p=0.003).
  • Focal type showed high ESRD-free survival (97% at 1 and 5 years), while sclerotic type had lower survival (49% at 1 and 5 years).
  • No significant difference in patient survival was observed between the histological groups (p=0.30).

Conclusions:

  • Histological classification is a valuable tool for predicting ESRD risk in elderly ANCA-GN patients.
  • Histological subtypes do not appear to be predictive of overall patient survival in this elderly cohort.
  • Findings support the use of histology for risk stratification concerning kidney outcomes in older ANCA-GN patients.
Abstract

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