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Abstract: SA-PO1077

A Proposal of Modified Berden’s Classification of ANCA-Associated Glomerulonephritis Focusing on a Proportion of Active Crescents for an Appropriate Treatment

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

  • Ogawa, Yayoi, Hokkaido Renal Pathology Center, Sapporo, Japan
  • Kobayashi, Takahisa, Jichi Medical University, Shimotsuke, Tochigi, Japan
  • Nagata, Daisuke, Jichi Medical University, Shimotsuke, Tochigi, Japan
  • Yumura, Wako, Department of nephrology, International University of Health and Welfare Hospital, Nasushiobara, Japan
  • Joh, Kensuke, Tohoku University Graduate School of Medicine, Sendai-city, Japan
Background

In 2010, Berden et al. proposed the histological classification of ANCA-associated glomerulonephritis and categorized sclerotic(S), focal(F), crescentic(C), and mixed (M) classes. The validation studies confirmed the best renal prognosis for F and the worst for S. However, the results of C and M were inconsistent. Therefore, we modified the Berden’s classification by focusing on a pure proportion of active crescents in each C and M from a view point of a further choice of therapy and analyzed the correlation between these subclasses and renal prognosis.

Methods

The 35 patients with MPO-ANCA-associated glomerulonephritis (male 57%, 68±7.8 yrs), who were followed more than 5 years, were analyzed. E-GFR at entry was 23.7±21.7ml/min per 1.73m2. In the modified classification, at the first step. S, F and C or M were categorized according to the Berden’s original classification. At the second step, in the category of C or M, New Crescent class (NC) was categorized by active crescents with more than 50% after eliminating global sclerosis and the rest were categorized as New Mixed class (NM), because the global sclerosis in the category of C or M did not respond to the immunosuppressive therapy. In each category, cumulative risk of ESRD (0-5 yrs) and ΔeGFR or ΔCr (serum creatinine) (0-5 yrs) were evaluated

Results

F: C: M: S were 13:5:9:8 respectively, whereas F: NC: NM: S were 13:7:7:8 respectively. Cumulative risk of ESRD (0-5 yrs) showed that F and S revealed best and worst prognosis, respectively (log rank p<0.05). C and M were in the middle, and the prognoses of C and M were not significantly different. However, NC and NM showed significant difference for ΔeGFR (0-5 yrs) and ΔCr (0-5 yrs) . A significant cut off point of a percent of active crescent for ΔeGFR (0-5 yrs) was 50% but not 25% or 75%. Therefore, NC showed a significant better eGFR-improvement than that of NM (p<0.05) indicating a better response to immunosuppressive therapy.

Conclusion

A modified Berden’s classification showed clear discrimination between NC and NM and can propose an appropriate rationale for a further choice of immunosuppressive therapy.