Risk Factors for Renal Survival in Chinese Patients with Myeloperoxidase-ANCA-Associated GN.
OBJECTIVE
Our study explored the association of histopathologic classification of ANCA-associated GN with renal survival in Chinese patients with myeloperoxidase-ANCA-associated GN.


METHODS
Two hundred fifteen patients with biopsy-proven myeloperoxidase-ANCA-associated GN were included from January of 1996 to December of 2014. The biopsies included focal (n=27), mixed (n=82), crescentic (n=47), and sclerotic (n=59) classes. The long-term renal outcome and risk factors of myeloperoxidase-ANCA-associated GN for different histopathologic classes were retrospectively analyzed.


RESULTS
During a median follow-up time of 22 (9-51) months, 88 (40.9%) patients reached ESRD. The 5-year renal survival (overall 58.7%) was highest in the focal class (100.0%) and lowest in the sclerotic class (20.7%), with no difference between the mixed (58.9%) and crescentic (67.4%) classes. Patients in the mixed (hazard ratio, 0.34; 95% confidence interval, 0.20 to 0.57;P<0.001) and crescentic (hazard ratio, 0.31; 95% confidence interval, 0.16 to 0.59;P<0.001) classes were at lower risk for ESRD compared with patients in the sclerotic class, as were patients who received glucocorticoids plus mycophenolate mofetil (hazard ratio, 0.32; 95% confidence interval, 0.18 to 0.60;P<0.001) compared with those receiving glucocorticoids alone. In addition, patients with a serum creatinine level ≥4 mg/dl (hazard ratio, 2.93; 95% confidence interval, 1.77 to 4.85;P<0.001) or hypoalbuminemia (hazard ratio, 2.11; 95% confidence interval, 1.32 to 3.34;P=0.002) were at higher risk for ESRD. A serum creatinine level ≥4 mg/dl and a percentage of global sclerotic glomeruli ≥60% were the two independent risk factors for ESRD in the sclerotic class.


CONCLUSIONS
The histopathologic classification of ANCA-associated GN in combination with serum creatinine and serum albumin levels and treatment regimen is associated with renal outcome in myeloperoxidase-ANCA-associated GN. The evaluation of serum creatinine level and percentage of global sclerotic glomeruli provides additional information on the risk of renal survival in the sclerotic class of myeloperoxidase-ANCA-associated GN.
National Clinical Research Centre of Kidney Diseases, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Yinghua
Y
Chen
Hao
H
Bao
Zhengzhao
Z
Liu
Xia
X
Liu
Erzhi
E
Gao
Caihong
C
Zeng
Haitao
H
Zhang
Zhihong
Z
Liu
Weixin
W
Hu
D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications* / Q000188:drug therapy; D001706:Biopsy; D002681:China; D003401:Creatine / Q000097:blood; D004359:Drug Therapy, Combination; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000150:complications* / Q000188:drug therapy / Q000201:enzymology / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications; D007676:Kidney Failure, Chronic / Q000209:etiology*; D007678:Kidney Glomerulus / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D009195:Peroxidase / Q000378:metabolism; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
D004791:Enzyme Inhibitors; D005938:Glucocorticoids; D009195:Peroxidase; D009173:Mycophenolic Acid; D003401:Creatine
ANCA; Antibodies, Antineutrophil Cytoplasmic; Biopsy; Confidence Intervals; Follow-Up Studies; Glucocorticoids; Humans; Kidney Failure, Chronic; Kidney Glomerulus; Mycophenolic Acid; Neutrophils; Peroxidase; Retrospective Studies; Serum Albumin; glomerulonephritis; histopathology; hypoalbuminemia; kidney; mycophenolate mofetil; risk factors; vasculitis