title: Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors.
abstract: BACKGROUND
  Anti-neutrophil cytoplasm antibody (ANCA) associated vasculitis with renal involvement requires treatment with potentially toxic drugs to reduce morbidity and mortality, and there is a major challenge to determine clinical and histological features predictive of renal prognosis. The aim of our study was to evaluate the use of the 2010 international histological classification for ANCA-associated glomerulonephritis (AAGN) as a predictor of renal outcome when used in conjunction with other prognostic factors.
  
  
  METHODS
  One hundred and four patients with AAGN treated at our centre were included: 23 were classified as focal, 26 as crescentic, 48 as mixed and 7 as sclerotic. Renal outcomes were based on estimated glomerular filtration rate (eGFR) at 1 and 5 years, and on renal survival.
  
  
  RESULTS
  By univariate analysis, patients in the focal class had the best renal outcome, those in the sclerotic class the worst outcome, and those in the mixed and crescentic classes had intermediate renal survival. There was no significant difference in outcome between the mixed and crescentic classes. In multivariate models, histological class did not improve model fit or associate with renal outcome after adjusting for established prognostic factors. Lower percentage of normal glomeruli, greater degree of tubular atrophy (TA), MPO-ANCA positivity, increasing age and lower starting eGFR, all correlated with poorer renal outcomes.
  
  
  CONCLUSIONS
  We conclude that, in our cohort of patients, the international histological classification is predictive of renal outcome in AAGN, but did not appear to be additionally informative over other established prognostic factors in multivariate analysis. However, it may be of value to combine the current histological classification with other established parameters, such as TA and percentage normal glomeruli.
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Anisha
authors.initials: A
authors.lastname: Tanna
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Guarino
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Frederick W K
authors.initials: FW
authors.lastname: Tam
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodriquez-Cubillo
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Levy
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Tom D
authors.initials: TD
authors.lastname: Cairns
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Megan
authors.initials: M
authors.lastname: Griffith
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Tarzi
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, London, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Caplin
authors.affiliation: UCL Centre for Nephrology, Royal Free Hospital, London, UK.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Salama
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
authors.forename: Terence
authors.initials: T
authors.lastname: Cook
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK c.pusey@imperial.ac.uk.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Pusey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood / Q000145:classification*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D007390:International Agencies; D007668:Kidney / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic
keywords: ANCA; clinical outcome; glomerulonephritis; renal pathology; vasculitis