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Kidney Week

Abstract: PO1628

Renal Histological Biomarkers and Response to Different Induction Regimens in ANCA-Associated Glomerulonephritis: The REASSESS Study

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Uzzo, Martina, Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Milan, Italy
  • Scott, Jennifer, The University of Dublin Trinity College, Dublin, Ireland
  • Guerini, Alice Ag, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • Affatato, Stefania, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • Lacetera, Rosanna, Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Milan, Italy
  • Kronbichler, Andreas, Medizinische Universitat Innsbruck Department fur Operative Medizin, Innsbruck, Tirol, Austria
  • Gunnarsson, Iva, Karolinska Universitetssjukhuset, Stockholm, Sweden
  • Allinovi, Marco, Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
  • La Manna, Gaetano, Dialysis and Renal Transplant Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
  • Cozzolino, Mario, Department of Health Sciences, Renal Division, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
  • Bruchfeld, Annette, Linkopings universitet, Linkoping, Östergötland, Sweden
  • Mescia, Federica, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • Pieruzzi, Federico, Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Milan, Italy
  • McAdoo, Stephen Paul, Imperial College London, London, London, United Kingdom
  • Sinico, Renato Alberto, Department of Medicine and Surgery, University of Milano-Bicocca and ASST Monza, Milan, Italy
  • Crnogorac, Matija, Department of Nephrology and Dialysis, Agram Special Hospital, Zagreb, Croatia
  • Scolari, Francesco, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
  • Little, Mark Alan, The University of Dublin Trinity College, Dublin, Ireland
  • Jayne, David R.W., University of Cambridge, Cambridge, Cambridgeshire, United Kingdom
  • Alberici, Federico, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Background

The role of kidney biopsy on ANCA-associated vasculitis (AAV) is still debated: despite its significant prognostic value, whether it has an impact on the induction regimen choice has not been explored yet.

Methods

323 AAV patients with biopsy-proven renal involvement were collected retrospectively from eleven centers and stratified according to the histopathological characteristics at the kidney biopsy and the induction regimen employed.

Results

The median follow-up time was 36 months; the eGFR was 19 ml/min/1,73m2; 53% were MPO-ANCA and 41% PR3-ANCA. 58% were treated with Cyclophosphamide (CYC), 18% with Rituximab (RTX) and 24% with RTX-CYC. According to the Berden classification, 24% biopsies were classified as Focal, 31% as Crescentic, 33% as Mixed and 12% as Sclerotic. Renal remission rate at 6 months and relapse-free survival were comparable in the different groups.
In the unadjusted survival analysis with the K-M curve, patients in the Crescentic group treated with RTX had a shorter ESRD-free survival compared to the CYC group (p=0.033) and the RTX-CYC one (p=0.044). This was confirmed with a Cox regression analysis adjusted for sex, age, ANCA type, AAV diagnosis, creatinine and proteinuria when comparing the RTX group with the CYC one (HR 8.30 [95% CI 1.64-42.01], p=0.011).

Conclusion

Response rates and relapse risk were comparable in the overall cohort and in each histopathological subgroup. The ESRD-free survival in the Crescentic class was shorter in the RTX group compared to the CYC one.