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Histopathological Classification-A Prognostic Tool for Rapidly Progressive Glomerulonephritis.

Marta Kantauskaitė1, Agnė Laučytė-Cibulskienė2,3, Marius Miglinas4,5

  • 1Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT⁻08661 Vilnius, Lithuania. marta.kantauskaite@santa.lt.

Medicina (Kaunas, Lithuania)
|October 23, 2018
PubMed
Summary

Histopathological classification aids in predicting outcomes for rapidly progressive glomerulonephritis (RPGN). Predominant glomerular sclerosis and low baseline eGFR indicate a higher risk of end-stage renal disease (ESRD) in crescentic glomerulonephritis.

Keywords:
ANCA associated glomerulonephritiscrescentic glomerulonephritishistopathological classificationrapidly progressive glomerulonephritisrenal outcome

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Area of Science:

  • Nephrology
  • Pathology
  • Clinical Medicine

Background:

  • A recent histopathological classification shows prognostic value in pauci-immune glomerulonephritis.
  • This study investigated if this classification extends to all forms of rapidly progressive glomerulonephritis (RPGN).

Purpose of the Study:

  • To evaluate the prognostic significance of a histopathological classification in diverse types of rapidly progressive glomerulonephritis.
  • To determine if histological patterns predict patient outcomes, including end-stage renal disease (ESRD) or death.

Main Methods:

  • Retrospective analysis of 73 patients diagnosed with RPGN between 1999 and 2015.
  • Renal biopsies were classified into focal, sclerotic, crescentic, and mixed categories.
  • Cox regression analysis was used to model survival, with endpoints of ESRD or death.

Main Results:

  • The sclerotic histological group and a baseline estimated glomerular filtration rate (eGFR) below 15 mL/min were associated with unfavorable renal survival.
  • The sclerotic group showed a hazard ratio of 3.679 (p < 0.05) for poor renal survival.
  • Low baseline eGFR (<15 mL/min) had a hazard ratio of 4.832 (p < 0.01) for poor renal survival.

Conclusions:

  • Predominant glomerular sclerosis and low baseline eGFR are linked to an increased risk of ESRD in crescentic glomerulonephritis.
  • Histological classification, regardless of injury origin, can assist in predicting patient outcomes in RPGN.
  • This classification may offer valuable prognostic information for managing RPGN patients.