title: Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis.
abstract: Renal vasculitis is one of the most common manifestations of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) and renal histology is a key predictor of the outcome. A new histopathologic classification was proposed and validated, but the results are still debated.
  
  
  
  We performed a retrospective analysis to validate the histopathologic classification and performed a metaanalysis to evaluate its predictive value. There were 186 patients with ANCA-associated renal vasculitis diagnosed at Ruijin Hospital who were enrolled in the retrospective study. The metaanalysis considered the data for 1601 patients.
  
  
  
  In our retrospective study, patients with focal class had the best renal outcome while patients with mixed class had the worst (p < 0.001). Metaanalysis showed that patients with focal class had better renal outcome than did those with crescentic class [risk ratio (RR) 0.23, 95% CI 0.16-0.34, p < 0.00001], with no evidence of heterogeneity (I2= 0%, p = 0.96). Patients with crescentic class had better renal outcome than did those with sclerotic class (RR 0.52, 95% CI 0.41-0.64, p < 0.00001), with no evidence of heterogeneity (I2= 2%, p = 0.43). We did not find statistical significance regarding renal outcome between mixed and crescentic classes (RR 1.14, 95% CI 0.91-1.43, p = 0.27), with no evidence of heterogeneity (I2= 23%, p = 0.19). The retrospective study showed that lung and upper respiratory tract involvement were the most common extrarenal manifestations.
  
  
  
  We demonstrated the clinical utility of histopathologic classification in determining renal outcome in patients with AAV. Metaanalysis showed that patients with focal class had the best outcome while sclerotic class had the worst.
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Yong-Xi
authors.initials: YX
authors.lastname: Chen
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Xiao-Xia
authors.initials: XX
authors.lastname: Pan
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Ping-Yan
authors.initials: PY
authors.lastname: Shen
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Xiao
authors.initials: X
authors.lastname: Li
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Hong
authors.initials: H
authors.lastname: Ren
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Xiao-Nong
authors.initials: XN
authors.lastname: Chen
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Ni
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China. zhangwen255@163.com chen-nan@medmail.com.cn.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine. zhangwen255@163.com chen-nan@medmail.com.cn.
authors.forename: Wen
authors.initials: W
authors.lastname: Zhang
authors.affiliation: From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.|Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
authors.forename: Nan
authors.initials: N
authors.lastname: Chen
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000276:immunology / Q000473:pathology*; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000276:immunology*; D001706:Biopsy; D018450:Disease Progression; D006801:Humans; D007668:Kidney / Q000276:immunology / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic
keywords: ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; HISTOPATHOLOGIC CLASSIFICATION; METAANALYSIS; OUTCOME; RENAL VASCULITIS