Kidney Week

Abstract: SA-PO653

Histopathologic Predictors for Renal Outcome in Crescentic Glomerulonephritis

Session Information

• Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Jung, Hee-Yeon, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Hee-Yeon Jung,

• Lim, Jeong-Hoon, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Jeong-Hoon Lim,

• Han, Man-hoon, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Man-hoon Han,

• Choi, Ji-Young, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Ji-Young Choi,

• Cho, Jang-Hee, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Jang-Hee Cho,

• Kim, Chan-Duck, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Chan-Duck Kim,

• Kim, Yong-Lim, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Yong-Lim Kim,

• Lee, Hajeong, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Hajeong Lee,

• Moon, Kyung chul, Seoul National University College of Medicine, Seoul, Korea (the Republic of)

Kyung chul Moon,

• Kim, Yong-Jin, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Yong-Jin Kim,

• Park, Sun-Hee, Kyungpook National University School of Medicine, Daegu, Korea (the Republic of)

Sun-Hee Park,

Background

Crescentic glomerulonephritis (CGN) results in serious decline of renal function, but the prognostic factors are not known in detail. We evaluated the long-term renal outcome and prognostic predictors of CGN according to histopathologic information obtained by renal biopsy.

Methods

Among 133 patients diagnosed as CGN between 2010 and 2018 from two university-based hospitals, we retrospectively analyzed 117 patients whose biopsy specimen contained more than 10 glomeruli. Specimens were categorized into four classes according to anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis classification. The severity of arterial fibrointimal thickening was assessed by semi-quantitative method between grade 0 and 3. Cox proportional analysis was used to calculate hazard ratio (HR) for renal survival and linear regression analysis was performed for one-year estimated glomerular filtration rate (eGFR).

Results

The mean age was 60.9 ± 15.5 years and male was 49.6%. The mean eGFR was 19.5 ± 16.5 mL/min/1.73m² and hemodialysis was required in 38 patients (32.5%) initially. Ninety-one patients (77.8%) showed positive for ANCA and 11 patients (9.4%) showed positive for anti-glomerular basement membrane antibody. Fifty-nine patients (50.4%) had advanced to end-stage renal disease (ESRD) during the mean follow-up of 34.1 month. Patients with sclerotic type had worse renal survival than focal type (HR, 3.30 [95% CI, 1.18–9.17], P=0.022), and moderate to severe arterial fibrointimal thickening was also associated with poor renal survival (grade 2: HR, 2.51 [95% CI, 1.18–5.37], P=0.017; grade 3: HR, 2.82 [95% CI, 1.21–6.57], P=0.016). Tubulointerstitial rounded dense lymphocyte aggregation was observed in 42 patients (35.9%) and was also a prognostic factor for ESRD (HR, 1.76 [95% CI, 1.03–2.99], P=0.039). In the multivariate linear regression analysis, sclerotic type, severe tubular atrophy, age, and baseline eGFR were independent predictors of eGFR at one year after biopsy (all, P<0.05).

Conclusion

Specific histopathologic findings, such as higher proportion of sclerotic glomeruli, moderate to severe arterial fibrointimal thickening, and presence of tubulointerstitial lymphocyte aggregation, provide helpful information for predicting the renal outcome in patients with CGN.