Abstract: TH-PO0750
Relationship of Kidney Function Recovery and Crescentic Lesions in ANCA-Associated Vasculitis
Session Information
- Glomerular Histopathology: Evolving Insights
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Murthy, Priyanka P, The University of Manchester Faculty of Biology Medicine and Health, Manchester, England, United Kingdom
- Tangwanchai, Taksaporn, The University of Manchester Faculty of Biology Medicine and Health, Manchester, England, United Kingdom
- Barrett, Emma, Manchester University NHS Foundation Trust, Manchester, England, United Kingdom
- Brix, Silke R., The University of Manchester Faculty of Biology Medicine and Health, Manchester, England, United Kingdom
Background
ANCA vasculitides destruct the glomerular structure and often cause rapid loss of kidney function. The expected norm of kidney function recovery at 3, 6 and 12 months as surrogate endpoints for long term kidney survival have not been defined. We investigated our single centre cohort of ANCA vasculitis patients with biopsy proven glomerulonephritis for the relationship of preserved normal glomeruli and cellular crescentic lesions impacting the potential to recover kidney function.
Methods
We performed a retrospective single centre cohort analysis.
Results
A total of 289 patients (2006 – 2025) were retrospectively reviewed (48.3% female, 45.5% anti-myeloperoxidase antibody positive, median age 65 years, interquartile range 54-73 years). Median creatinine at time of diagnosis was 232 umol/l, IQR 126.5 – 395.5 umol/l (estimated glomerular filtration rate, eGFR 21 mls/min, IQR 10.3-43.8 mls/min). Median creatinine/eGFR at 3, 6 and 12 months was 176.5, 162 and 156 umol/l and 29, 30.5 and 33.0 mls/min, respectively. During follow up 60 patients died, 48 patients developed end stage kidney disease. The kidney biopsies demonstrated a median of 33.3% normal glomeruli and 18.9% cellular crescents.
Correlation analysis showed that the percentage of normal glomeruli associated with kidney function at all time points. Kidney function was better with rising percentage of normal glomeruli at the time of diagnosis and during follow up (p<0.0001, p<0.0001, p<0.0001, p<0.0001, respectively). There was an inverse correlation of cellular crescents with kidney function from the time of diagnosis that diminished over time (p<0.0001, p=0.0009, p=0.0007, p=0.0033). The change in kidney function (Δcreatinine and ΔeGFR over 3, 6 and 12 months) was influenced by normal and crescentic glomeruli but the change in function was less evident over the longer follow-up of 12 months than the first 3 months. A higher percentage of cellular crescents correlated with a reduced improvement in function (p<0.0001). A less prominent association was seen with percentage of normal glomeruli associating with an increase in function (p=0.0003).
Conclusion
The inverse association of crescentic lesions and kidney function recovery challenges the assumption that more aggressive disease presentations and a higher percentage of active lesions carry a higher recovery potential.
Funding
- Government Support – Non-U.S.