title: The predictive value of kidney biopsy in renal vasculitis: a multicenter cohort study.
abstract: The histopathologic classification of antineutrophil cytoplasmic antibody-associated vasculitis has been demonstrated to have prognostic value in small cohorts of patients with pauci-immune extracapillary glomerulonephritis. We aimed to validate this histologic subgrouping system in a large cohort of patients with renal vasculitis from 3 Spanish centers. The additional value of several histologic parameters for predicting renal outcome was investigated. A total of 151 biopsies of patients with renal vasculitis were reviewed and classified as follows: 41% crescentic, 24% mixed, 21% focal, and 14% sclerotic. The cumulative proportions of renal survival at 5 years were 83.2%, 81.2%, 60.5%, and 50.7% for the focal, mixed, crescentic, and sclerotic categories, respectively (P < .05). In the crescentic category, patients with less than 75% of glomeruli showing crescents had better survival at 1 and 5 years compared with those having greater than or equal to 75% of crescents (77.9% and 70.6% versus 51.3% and 45.6%; P = .02). When adjusted by renal function and other histologic parameters, the percentage of extracapillary proliferation and glomerulosclerosis remained as significant predictors for renal survival (hazard ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .001, and hazard ratio, 1.03; 95% confidence interval, 1.01-1.05; P = .002, respectively). In conclusion, patients with pauci-immune crescentic glomerulonephritis experienced different outcomes depending on the percentage of crescents observed, so that extensive extracapillary proliferation was associated with the poorest renal survival. These findings validate the prognostic utility of the histologic classification scheme in antineutrophil cytoplasmic antibody positive and negative patients and suggest a subdivision of crescentic category (<75% and ≥75% of crescents) based on the different survival rates observed among these subgroups.
authors.affiliation: Department of Pathology, Hospital Virgen de la Salud, Toledo, 45004, Spain. Electronic address: franciscod65@yahoo.com.
authors.forename: Francisco
authors.initials: F
authors.lastname: Diaz-Crespo
authors.affiliation: Department of Nephrology, Hospital Universitario Fundacion Alcorcon, 28922, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Villacorta
authors.affiliation: Department of Nephrology, Hospital Virgen de la Salud, Toledo, 45004, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Acevedo
authors.affiliation: Department of Nephrology, Hospital Universitario Doce de Octubre, Madrid, 28041, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cavero
authors.affiliation: Department of Pathology, Hospital Universitario Fundacion Alcorcon, 28922, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerrero
authors.affiliation: Department of Nephrology, Hospital Virgen de la Salud, Toledo, 45004, Spain.
authors.forename: Eugenio
authors.initials: E
authors.lastname: García Díaz
authors.affiliation: Department of Pathology, Hospital Virgen de la Salud, Toledo, 45004, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Orradre
authors.affiliation: Department of Pathology, Hospital Universitario Doce de Octubre, Madrid, 28041, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Martinez
authors.affiliation: Department of Nephrology, Hospital Universitario Doce de Octubre, Madrid, 28041, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Praga
authors.affiliation: Department of Nephrology, Hospital Universitario Fundacion Alcorcon, 28922, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Fernandez-Juarez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D001706:Biopsy; D049109:Cell Proliferation / Q000187:drug effects; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D007678:Kidney Glomerulus / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012074:Remission Induction; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Antineutrophil cytoplasmic antibody; Crescent; Glomerulonephritis; Kidney; Vasculitis