Abstract: SA-PO253
Predictors of Renal Outcomes in Sclerotic Class ANCA GN
Session Information
- Clinical Glomerular Disorders: Vasculitis, C3G, IgAN
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Glomerular
- 1005 Clinical Glomerular Disorders
Authors
- Menez, Steven, Johns Hopkins Medicine, Baltimore, Maryland, United States
- Alasfar, Sami, None, Rosedale, Maryland, United States
- Hruskova, Zdenka, Department of Nephrology,General University Hospital and First Faculty of Medicine, Charles University, Prague 2, Czechia
- Scott, Jennifer Orna, None, Rosedale, Maryland, United States
- Chen, Min, Peking University First Hospital, Peking, China
- Little, Mark Alan, Trinity College Dublin, Dublin, Ireland
- Tesar, Vladimir, None, Rosedale, Maryland, United States
- Geetha, Duvuru, John Hopkins Bayview Medical Center, Baltimore, Maryland, United States
Background
The ANCA GN classification has been shown to have prognostic value in ANCA associated glomerulonephritis (GN) with sclerotic class portending poor renal outcomes. Relevant published data on factors predicting outcomes in sclerotic ANCA GN is limited and these patients are not well covered in published guidelines.
Methods
Patients were recruited from 1998-2016 from 4 centers worldwide (N= 45) for this retrospective cohort study. All patients had biopsy proven sclerotic ANGN with > 50% of sampled glomeruli showing global sclerosis. We describe the clinical characteristics of this cohort and evaluate predictors of one year GFR and ESRD. Descriptive data are described as mean (SD). Logistic and linear regression models were used as appropriate.
Results
Of the 45 patients, 91% were Caucasian and 58% male with a mean age of 60 years. 80% had new diagnosis, 71% had renal limited disease and 84% were MPO ANCA positive. Kidney biopsies contained a mean (SD) 25 (18) glomeruli, mean (SD) % sclerosed glomeruli was 69(12) with 96% showing moderate to severe interstitial fibrosis (IF). 43 patients received immunosuppressive therapy: 69% pulse solumedrol, 71% cyclophosphamide, 24% rituximab and 18% received plasmapheresis. Disease remission was achieved in all. The mean (SD) eGFR at entry was 15 (18) and at 1 year was 17(13) ml/min/1.73m2. Entry GFR, rituximab use and IF but not % normal glomeruli were predictive of 1 year GFR (Table1). Over a mean (SD) follow up of 60 (58) months, 25 patients reached ESRD and baseline GFR predicted risk of ESRD (p=0.04).
Conclusion
Entry GFR, use of RTX and lesser degree of IF predicted better GFR at 1 year in sclerotic ANCA GN. Further studies are needed to validate these findings.
Predictors of GFR at 12 Months
| Correlation coefficient or mean difference | Confidence interval | P-value | |
| Age | 0.15 | (-0.15 - 0.45) | 0.31 |
| Gender (Female) | 0.67 | (-8.33 - 9.68) | 0.88 |
| ANCA type (PR3) | 3.6 | (-9.29- 16.59) | 0.57 |
| GFR at Entry | 1.27 | (.90 - 1.63) | <0.0005 |
| Use of RTX versus CYC | 19.285 | (10.65 - 27.91) | <0.0005 |
| Glomerular Sclerosis >75% | 6.15 | (-4.016 - 16.31) | 0.23 |
| Percentage of normal glomeruli >2% | -1.69 | (-10.80 - 7.4) | 0.75 |
| Degree of Intersitial Fibrosis | -8.56 | (-15.88 -- -1.23) | 0.0001 |