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Evaluation of three scoring systems for predicting renal prognosis in antineutrophil cytoplasmic antibody-associated
Ruiqiang Wang1, Xiaofeng Zhang2, Xinfang Wang2
1Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, No.1 Jianshe Road, Zhengzhou, 450052, Henan, China. wangruiqiang@zzu.edu.cn.
Insights
A new scoring system combining renal vascular lesions (RVLs) and renal risk score (RRS) significantly improves prediction of kidney disease progression in ANCA-associated glomerulonephritis (AAGN). This combined score (RR) offers superior prognostic value over existing measures for AAGN patients.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) is a severe kidney disease requiring prompt treatment to prevent end-stage renal disease (ESRD).
- Accurate prediction of renal prognosis is crucial for managing AAGN and optimizing patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of the renal risk score (RRS), Birmingham vasculitis activity score (BVAS), and renal vascular lesions (RVLs) score for renal prognosis in AAGN.
- To identify the most effective scoring system for predicting kidney disease progression in AAGN patients.
Main Methods:
- Retrospective analysis of 94 AAGN patients diagnosed via renal biopsy.
- Evaluation of RRS, BVAS, and RVLs score against clinicopathologic features and renal outcomes.
- Receiver operating characteristic (ROC) curve analysis to determine the prognostic value of each score and their combinations.
Main Results:
- The combined score of RVLs and RRS (RR) demonstrated superior predictive power (AUC 0.910) compared to RRS (0.865), BVAS (0.624), and RVLs score (0.763) alone.
- The combination of RVLs, RRS, and BVAS (RRB) showed the highest predictive accuracy (AUC 0.942).
- A linear equation was derived: RR = -0.4766 + 0.1231 × RVLs score + 0.395 × RRS, highlighting the significant contribution of RVLs and RRS to predicting renal prognosis.
Conclusions:
- The combined RR score offers superior prediction of renal prognosis in AAGN compared to RRS, BVAS, and RVLs score individually.
- The RR score represents a promising new tool for predicting renal outcomes in patients with AAGN, aiding clinical decision-making.
Background:
Antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) is characterized by rapidly progressive glomerulonephritis, and timely initiation of treatment and evaluation is critical to prevent the progression of renal disease to end-stage renal disease (ESRD). The aim of this study was to evaluate predictive value of the renal risk score (RRS), Birmingham vasculitis activity score (BVAS), and renal vascular lesions (RVLs) score for renal prognosis in AAGN.
Methods:
A retrospective analysis of ninety-four patients diagnosed with AAGN after renal biopsy was performed. The RRS, BVAS, and RVLs score were evaluated in relation to clinicopathologic features and renal prognosis. A receiver operating characteristic curve (ROC) was used to evaluate their renal prognostic value.
Results:
The median follow-up time was 36 months. Thirty-eight patients progressed to ESRD. Survival analysis showed that renal prognosis worsened in the RRS group in order of low, medium, and high RRS (P < 0.05). Within the RVLs group, the renal prognosis of the groups with severe and moderate RVLs was worse than that of the group without RVLs (P = 0.012, P < 0.001), and the group with mild RVLs was close to that of the group without RVLs. ROC analysis showed that the AUC of RRS, BVAS, RVLs score, RVLs score combined with RRS (RVLs score & RRS, RR), RVLs score, and RRS combined with BVAS (RVLs score & RRS & BVAS, RRB) were 0.865, 0.624, 0.763, 0.910, and 0.942, respectively. The predictive power of RRB and RR was comparable and significantly better than the RRS, BVAS, and RVLs score. Based on simplicity and validity, RR was selected as the best predictor, and the relationship between RRS, RVLs score, and RR was calculated using a linear fit, resulting in the linear equation RR = -0.4766 + 0.1231 × RVLs score + 0.395 × RRS (P < 0.001).
Conclusions:
In AAGN, the predictive power of RR for renal prognosis was superior to that of RRS, BVAS, and RVLs score. RR may serve as a new predictor of renal prognosis in AAGN.
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