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Abstract: FR-PO590

Histopathologic Prognostication of ANCA-Associated Vasculitis Using Banff Parameters

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Givi, Jerome Philip, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Akers, James Lewis, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Garrison, Adriana, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Shawwa, Khaled, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Kannabhiran, Dinesh, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
  • Amin, Md. Shahrier, West Virginia University Health Sciences Center, Morgantown, West Virginia, United States
Background

ANCA-associated vasculitis (AAV) with renal involvement makes up 80% of rapidly progressive glomerulonephritis cases. Our objective was to determine whether histopathologic parameters adapted from Banff provide prognostic information.

Methods

Biopsy slides from patients with AAV from 2008-2021 at West Virginia University Hospitals were reviewed. The biopsies were scored using an expanded Banff scoring system by a renal pathologist blinded to clinical data. Each histopathologic parameter was analyzed both individually and as part of a composite score, to determine association with eGFR and ESKD. Generalized estimating equation model was used to evaluate the association between the parameters and eGFR during follow-up. Proportional hazard model was used to investigate the association between the parameters to end-stage kidney disease (ESKD) (estimated glomerular filtration rate (eGFR) less than 15 ml/min/BSA or need for renal replacement therapy).

Results

Slides were available for review in 79 of 155 patients with AAV during the study period. Patients had a mean age of 63 years, 32 (41%) were females and 48 (61%) were MPO-ANCA. Having a crescent score (C) of C1 or C2 was associated with an eGFR decline of 8.19 ml/min/BSA (95% CI: -15.8 to -0.5, p=0.036) during follow up compared to C0. Percent of globally sclerosed glomeruli >25% compared to <10% was also associated with eGFR decline of 17.3 ml/min/BSA during follow up (95% CI: -29.2 to -5.3; p=0.005). Using a single composite score including crescent, vasculitis and total inflammation (CVI) showed that CVI > 3 (median value) was associated with a significant decline of eGFR during follow up compared to CVI < 3 (-15.6 ml/min/BSA, 95% CI:-24.3 to -3.6; p<0.001). Parameters that showed significant association with increased risk of ESKD include - interstitial fibrosis (ci>1 vs ci<1, hazard ratio, HR:2.6, 95% CI:1.1 to 6.4, p=0.03) and total inflammation (ti<1 vs ti>1; HR - 3.4, CI - 1.1 to 10.2, p=0.032).

Conclusion

A scoring system that reflects both active inflammation and chronicity provides prognostic information when considering treatment in patients with AAV. Further multicenter studies will be useful to further validate these parameters for clinical use.