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Modified histopathological classification with age-related glomerulosclerosis for predicting kidney survival in

Mehmet Fethullah Aydın1, Abdülmecit Yıldız2, Ayşegül Oruç2

  • 1Division of Nephrology, Faculty of Medicine, Bursa Uludağ University, 16059, Nilüfer, Bursa, Turkey. mfaydin@uludag.edu.tr.

International Urology and Nephrology
|September 25, 2022
PubMed

Insights

Modifying the ANCA-GN classification with age-related glomerulosclerosis improves prediction of kidney survival in ANCA-associated glomerulonephritis patients. This enhanced model offers greater statistical significance for renal outcomes.

Area of Science:

  • Nephrology
  • Pathology
  • Renal Medicine

Background:

  • The current histopathological classification for ANCA-associated glomerulonephritis (ANCA-GN) categorizes patients into four groups based on glomerular injury.
  • This established classification does not account for age-related glomerulosclerosis, a factor potentially impacting renal outcomes.
  • There is a need to evaluate if incorporating age-related glomerulosclerosis can improve the predictive accuracy of ANCA-GN classification for renal survival.

Purpose of the Study:

  • To compare the predictive power of the standard Berden's ANCA-GN histopathological classification against a modified version that includes age-related glomerulosclerosis.
  • To assess the impact of incorporating age-related glomerulosclerosis on the statistical significance of predicting renal survival in ANCA-GN patients.

Main Methods:

  • Retrospective analysis of demographic, laboratory, and histopathologic data from 65 ANCA-GN patients diagnosed between 2004 and 2019.
  • Comparison of renal survival predictions using both the classical Berden's ANCA-GN classification and a modified classification incorporating age-related glomerulosclerosis.
  • Multivariate Cox regression analysis was employed to identify independent factors influencing renal survival.

Main Results:

  • Berden's classification yielded statistically significant predictions for renal survival (p=0.022).
  • Modification with age-related glomerulosclerosis reclassified patients, notably shifting those in the 'sclerotic' group.
  • The modified classification demonstrated increased statistical significance in predicting renal survival (p=0.009), with global glomerulosclerosis percentage and serum creatinine identified as significant independent factors.

Conclusions:

  • Incorporating age-related glomerulosclerosis into the Berden's ANCA-GN histopathological classification may enhance its statistical significance.
  • The modified classification shows potential for improved prediction of renal survival in ANCA-GN.
  • Disease-related global glomerulosclerosis and serum creatinine are critical independent predictors of renal outcomes in ANCA-GN.
Abstract

Keywords:
ANCAANCA-associated vasculitisAge-related glomerulosclerosisAnti-neutrophil cytoplasmic antibodiesHistopathological classificationRenal pathology

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