Correlation of percentage of normal glomeruli with renal outcome in Wegener's granulomatosis.
OBJECTIVE
We examined the correlations between renal biopsy findings in Wegener's granulomatosis and renal function at baseline and 1 year in 22 patients who presented between 1988 and 1999.


METHODS
Renal histology was independently reviewed by 2 pathologists who were masked to the clinical data. The primary outcome was the relationship of the percentage of normal glomeruli to reciprocal serum creatinine at baseline and 1 year. Other histologic data were collected using a series of ordinal rating scales. Acute and chronic sum scores were calculated.


RESULTS
The median serum creatinine (SCr) at baseline was 3.9 mg/dl (0.8-14 mg/dl). Seven patients initially required hemodialysis, of whom 4 subsequently regained independent renal function. By 1 year of follow-up, the median (SCr) for patients with independent renal function was 1.9 mg/dl (0.9-6.8 mg/dl). Reciprocal SCr at baseline correlated with the percentage of normal glomeruli (r = 0.584, p = 0.005), crescent score (r = -0.595, p = 0.003), interstitial fibrosis as a percentage of cortical surface area (r = -0.669, p = 0.002), interstitial inflammation (r = -0.439, p = 0.041), eosinophil (r = -0.495, p = 0.019), neutrophil score (r = -0.557, p = 0.005), and acute sum score (r = -0.499, p = 0.018). However, only the percentage of normal glomeruli (r = 0.493, p = 0.023), the crescent score (r = -0.452, p = 0.035), and interstitial fibrosis as a percentage of cortical surface area (r = -0.466, p = 0.052) correlated with reciprocal SCr at 1 year of follow-up.


CONCLUSIONS
In this relatively small data set, the percentage of normal glomeruli, the crescent score, and interstitial fibrosis as a percentage of cortical surface area correlated with renal function at both baseline and 1 year of follow-up.
Haroun
Melanie K
MK
Division of Nephrology, The Johns Hopkins Vasculitis Center, Department of Medicine, Baltimore, Md. 21205, USA. mharoun1@jhem.jhmi.edu
Stone
John H
JH
Nair
Ramesh
R
Racusen
Lorraine
L
Hellmann
David B
DB
Eustace
Joseph A
JA
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D005260:Female; D005355:Fibrosis / Q000473:pathology; D014890:Granulomatosis with Polyangiitis / Q000473:pathology* / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
D003404:Creatinine