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Abstract: SA-PO1078

Utility of the Modified Berden’s Histological Classification of ANCA Vasculitis for a Choice of Immunosuppressive Therapy

Session Information

Category: Pathology and Lab Medicine

  • 1502 Pathology and Lab Medicine: Clinical

Authors

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

For a rationale of the therapeutic choice for ANCA vasculitis, a quantitative assessment of the active crescents (AC) is indispensable. Since a newly proposed modified Berden’s classification (Ogawa Y et al. 2018) focusses a ratio of remaining active crescents, we evaluated a utility of this classification for a choice of therapy by evaluating a correlation between this classification and the clinical profile.

Methods

The 35 patients (pts) with MPO-ANCA-associated glomerulonephritis (male 57%, 68.6 +-7.8 years old), who were followed more than 5 years were analyzed in the present retrospective study. All pts were treated according to the Japanese guideline (JSN 2011). In the modified classification, after classifying Sclerotic (S) Focal (F) and crescent (C) or mixed (M) classes with a cut-off point of 50%, New Crescent class (NC) was categorized by active crescents with more than 50% after eliminating global sclerosis and the rest was categorized as New Mixed class (NM) in the category of C or M. Clinical information including serum creatinine (sCr), eGFR and grade of hematuria (GH) at onset as well as at 5-years (yrs) after renal biopsy, and amelioration of sCr per day (ΔCr/day) were retrieved.

Results

Percent of AC correlated positively with GH (r=0.337, p<0.05), sCr (r=0.474,p<0.01), and negatively with eGFR at admission(r=-0.488, p<0.01)and ΔCr/day(r=-0.420, p<0.05). Moreover, 8 mL/min of eGFR was a cut off point for 5 year’s renal prognosis, because 50% of the pts with eGFR more than 8 mL/min in the S showed ESRD, whereas no pts with eGFR more than 8mL/min developed ESRD in F, NC, and NM. On the other hand, 100%, 100%, 80%, and 50% of the pts with eGFR less than 8 mL/min developed ESRD in S, NM, NC, and F, respectively. ΔCr/day of the pts with NC(0.41 mg/dL/day) revealed significantly greater than that of pts with NM(0.05mg/dL/day). Cut off of the ΔCr to predict NC was ≧0.16 mg/dL/day.

Conclusion

A newly proposed modified Berden’s classification together with 8 mL/min of eGFR and 0.16 mg/dL/day of ΔCr as cut-off points were useful to predict the renal outcome and a response of immunosuppressive therapy.

Funding

  • Private Foundation Support