Kidney Week

Abstract: SA-PO658

A Proposal of a Stepwise Algorithm for Therapeutic Intervention Using a Modified EUVAS Classification

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

• Kobayashi, Takahisa, Jichi Medical University, Shimotsuke, Tochigi, Japan

Takahisa Kobayashi,

• Ogawa, Yayoi, Hokkaido Renal Pathology Center, Sapporo, Japan

Yayoi Ogawa,

• Yumura, Wako, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan

Wako Yumura,

• Joh, Kensuke, The Jikei University School of Medicine, Tokyo, Japan

Kensuke Joh,

• Nagata, Daisuke, Jichi Medical University, Shimotsuke, Tochigi, Japan

Daisuke Nagata,

Background

Prediction of treatment’s response is useful for minimizing the side effects of immunosuppression therapy for elderly patients. We proposed the Modified EUVAS histological classification of ANCA-associated glomerulonephritis (AAGN), in which New Crescent class (NC) was categorized by active crescents with more than 50% after eliminating a number of global sclerosis and the rest was categorized as New Mixed class (NM) (ASN2018). The purpose was to produce a stepwise algorithm consisting of clinical, histological, and prognostic assessments using the modified EUVAS classification.

Methods

The 51 patients with MPO-AAGN (male 45%, 68 +-9.1years old), who were followed more than 2 years were the cohort in the present retrospective study. All patients were treated according to the Japanese guideline (JSN 2011). In the clinical assessment, cut off values of basal eGFR and increases in sCr per day (ΔCr/day) predicting NC were decided using ROC analysis. In the second step, prognosis as well as treatment’s response of each subclass of modified EUVAS classification was analyzed.

Results

F:NC:NM:S was 18:11:11:11, respectively. In clinical assessment, 8 mL/min of eGFR₀ and 0.16 mg/dL/day of ΔCr were cut off values for renal prognosis and estimation of NC, respectively. In subtype NC, the proportion of normal glomeruli more than 10% was valuable indicator for prediction of treatment response (ΔeGFR_0-2). The renal function of NM was preserved without correlation with the proportion of normal glomeruli.

Conclusion

Patient with F or S will be treated conventionally. However, histological quantative assessment of NC and NM provides an idea of concrete immunosuppressant's therapy. Stepwise algorism consisting of clinical, histological and prognostic assessment as shown in Figure, is useful for minimizing the side effects of immunosuppression therapy for elderly patients.

Stepwise Algorithm using the modified EUVAS classification.