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Kidney Week

Abstract: TH-PO561

A Novel Activity and Chronicity Index for Histologic Assessment of Renal Biopsies in ANCA-Associated Vasculitis

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Procop, Alexandru F., Fundeni Clinical Institute, Bucharest, Romania
  • Terinte-Balcan, George, Victor Babes National Institute of Pathology, Bucharest, Romania
  • Jurubita, Roxana Adriana, Fundeni Clinical Institute, Bucharest, Romania
  • Vornicu, Alexandra, Fundeni Clinical Institute, Bucharest, Romania
  • Gherghiceanu, Mihaela, Victor Babes National Institute of Pathology, Bucharest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

Prediction of renal outcome in ANCA-associated vasculitis (AAV) remains a major challenge. We aimed to evaluate a novel score for histologic assessment of renal biopsies in AAV.

Methods

A semiquantitative activity (AI) and chronicity (CI) index were assessed in relation to achievement of remission or ESRD. The AI consisted of the percentage of normal glomeruli, cellular/fibrocellular crescents, fibrinoid necrosis, neutrophil infiltration, the severity of interstitial inflammation, the presence of tertiary lymphoid organs, arteritis and TMA. The CI consisted of a total glomerulosclerosis score, the percentage of glomeruli with fibrous crescents, the severity of IFTA and the presence of arteriosclerosis.

Results

27 patients with AAV were included in the study. Their mean age was 60±10 years, 70% were females and 74% had a pANCA-vasculitis. The baseline eGFR was 21±16 ml/min, while 70.4% of patients achieved a remission and 22.5% progressed to ESRD. The baseline eGFR significantly correlated with AI (r=-0.53;p=0.005), CI (r=-0.37;p=0.05) and individual components, cellular/fibrocellular crescent score (r=-0.44;p=0.02), interstitial inflammation score (r=-0.5;p=0.009) and tubular atrophy score (r=-0.38;p=0.04)(Figure 1). Non-responders had higher median AI [11.5 (IQR:6.5-16.25)], CI [8.5(IQR:5.7-10)] and cellular/fibrocellular crescent score [6(IQR:2.5-6)] compared to responders [8(IQR:5-12); 6(IQR:5-8) and 2(IQR:2-4), respectively]. Patients that progressed to ESRD had higher AI [11(IQR:6-13.2)] and fibrinoid necrosis score [3(IQR:1.5-4.5)] compared to non-progressors [8(IQR:5.5-14) and 0(IQR:0-4)].

Conclusion

This novel histologic score correlated with the baseline severity of renal involvement in AAV and may be useful for predicting the renal outcome.

Figure 1. Variables correlation.