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Abstract: FR-PO589

Histological Subtyping of Interstitial Infiltrates and Long-Term Validation of Renal Risk Score in ANCA-Associated Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Chalkia, Aglaia, Nephrology Department, Hippokration General Hospital,, Athens, Greece
  • Koutsianas, Christos, 2nd Department of Medicine and Laboratory, Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  • Giannou, Panagiota E., Nephrology Department, Hippokration General Hospital,, Athens, Greece
  • Agelis, Georgios, Nephrology Department, Hippokration General Hospital,, Athens, Greece
  • Gakiopoulou, Harikleia, 1st Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  • Panagiotopoulos, Alexandros G., 2nd Department of Medicine and Laboratory, Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  • Thomas, Konstantinos, 2nd Department of Medicine and Laboratory, Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  • Vassilopoulos, Dimitrios, 2nd Department of Medicine and Laboratory, Clinical Immunology - Rheumatology Unit, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
  • Petras, Dimitrios I., Nephrology Department, Hippokration General Hospital,, Athens, Greece
Background

Data on the prognostic significance of baseline renal histologic findings in ANCA-associated glomerulonephritis (AAGN) are limited.

Methods

Retrospective study of 38 patients with AAV and biopsy proven AAGN. Patients were categorized according to their histologic subtype and the composition of their interstitial inflammatory infiltrates as well as their risk for progression to end-stage renal disease (ESRD) according to their renal risk score were estimate.

Results

38 patients (mean age: 68 years, males:50%, MPA: 60%, anti-MPO+: 76%, mean follow-up: 48 months) were categorized into focal (n=9, 24%), mixed (n=12, 32%), crescentic (n=6, 16%) and sclerotic (n=8, 21%) subtypes while 3 patients had isolated tubulointerstitial nephritis (8%). In terms of interstitial infiltrates, mixed type biopsies (n=12) had more intense interstitial inflammation (67% vs 25%, p=0.029) with predominant eosinophilic (42% vs 13%, p=0.086) and macrophage (58% vs 16%, p=0.02) compared to the other types. Contrarily, in focal type we noticed absence of macrophage (0% vs39%, p=0.053) and limited neutrophilic (11% vs 54%, p=0.053) infiltration, compared to the rest. Patients with focal type demonstrated the lowest (HR 0.027 95% CI 0.009-3.238, p=0.09) and those with sclerotic type the highest (HR 5.95 95% CI 1.494-18.059, p=0.010) risk for ESRD progression. According to the renal risk score, the cumulative renal survival at 1, 2 and 5 years was 100% in the low- risk, 94% in the medium-risk and 50%, 38% and 18% respectively in the high-risk (p<0.0001). The high-risk group presented the highest risk for progression to ESRD (ΗR 25.29, 95% CI 3.145-203.38, p=0.002), compared to low/medium risk groups.

Conclusion

Our real-life study confirmed the value of histologic subtyping and the renal risk score for predicting ERSD progression in patients with AAGN. It also demonstrated that the cellular composition of interstitial infiltrates differs significantly according to the histologic subtype. These findings may have important implications for the understanding of the pathogenesis and prognosis of AAGN.

Funding

  • Other NIH Support