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The value of the current histological scores and classifications of ANCA glomerulonephritis in predicting long-term
Matteo Stella1,2, Laura Locatelli2, Filippo Maria Sala3
1Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Insights
The Renal Risk Score (RRS) and Mayo Clinic Chronicity Score (MCCS) predict kidney outcomes in anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN), unlike the Berden classification. These scores, along with hypertension and creatinine, are key for prognosis.
Area of Science:
- Nephrology
- Immunology
- Pathology
Background:
- Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) is a severe kidney disease.
- Histological scoring systems are used to predict ANCA-GN prognosis.
- Comparing the predictive power of different scoring systems is crucial for clinical management.
Purpose of the Study:
- To compare the histopathologic classification (Berden), Renal Risk Score (RRS), and Mayo Clinic Chronicity Score (MCCS) in predicting patient and kidney prognosis in ANCA-GN.
- To identify which histological scoring system is most effective for assessing ANCA-GN outcomes.
Main Methods:
- A retrospective study of 152 patients with biopsy-proven ANCA-GN and at least one year of follow-up.
- Renal biopsies were classified using Berden, RRS, and MCCS.
- Endpoints included end-stage kidney disease (ESKD) and ESKD or death.
Main Results:
- Both Berden and RRS scores were associated with kidney prognosis (ESKD or death).
- MCCS was also associated with both endpoints, particularly when comparing severity groups.
- Multivariate analysis showed RRS and MCCS remained predictive of ESKD, while Berden classification did not.
Conclusions:
- The Renal Risk Score (RRS) and Mayo Clinic Chronicity Score (MCCS) are independent predictors of kidney survival in ANCA-GN.
- High serum creatinine and arterial hypertension at diagnosis also predict poor kidney outcomes.
- The Berden classification was not found to be an independent predictor of kidney survival in this cohort.
Background:
Three different histological scores-histopathologic classification (Berden), Renal Risk Score (RRS) and the Mayo Clinic Chronicity Score (MCCS)-for anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (ANCA-GN) were compared to evaluate their association with patient and kidney prognosis of ANCA-GN.
Methods:
Patients aged >18 years with at least 1 year of follow-up and biopsy-proven ANCA-GN entered this retrospective study. Renal biopsies were classified according to Berden's classification, RRS and MCCS. The first endpoint was end-stage kidney disease (ESKD), defined as chronic dialysis or estimated glomerular filtration rate <15 mL/min/1.73 m2. The second endpoint was ESKD or death.
Results:
Of 152 patients 84 were males, with median age of 63.8 years and followed for 46.9 (interquartile range 12.8-119) months, 59 (38.8%) reached the first endpoint and 20 died. The Kaplan-Meier curves showed that Berden and RRS were associated with first (Berden: P = .004, RRS: P < .001) and second (Berden: P = .001, RRS: P < .001) endpoint, MCCS with the first endpoint only when minimal + mild vs moderate + severe groups were compared (P = .017), and with the second endpoint (P < .001). Among the clinical/histological presentation features, arterial hypertension [odds ratio (OR) = 2.75, confidence interval (95% CI) 1.50-5.06; P = .0011], serum creatinine (OR = 1.17, 95% CI 1.09-1.25; P < .0001), and the percentage of normal glomeruli (OR = 0.97, 95% CI 0.96-0.99; P = .009) were the independent predictors of ESKD at multivariate analysis. When the three scores were included in multivariate analysis, RRS (OR = 2.21, 95% CI 1.15-4.24; P = .017) and MCCS (OR = 2.03, 95% CI 1.04-3.95; P = .037) remained predictive of ESKD, but Berden (OR = 1.17, 95% CI 0.62-2.22; P = .691) did not.
Conclusion:
RRS and MCCS scores were independent predictors of kidney survival together with high serum creatinine and arterial hypertension at diagnosis, while Berden classification was not.
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