Risk Factors for Renal Survival in Chinese Patients with Myeloperoxidase-ANCA-Associated GN

• Published in: Clinical journal of the American Society of Nephrology Vol. 12; no. 3; pp. 417 - 425
• Main Authors: Chen, Yinghua, Bao, Hao, Liu, Zhengzhao, Liu, Xia, Gao, Erzhi, Zeng, Caihong, Zhang, Haitao, Liu, Zhihong, Hu, Weixin
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 07.03.2017
• Subjects: Adult; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - drug therapy; Biopsy; China; Creatine - blood; Drug Therapy, Combination; Enzyme Inhibitors - therapeutic use; Female; Follow-Up Studies; Glomerulonephritis - complications; Glomerulonephritis - drug therapy; Glomerulonephritis - enzymology; Glomerulonephritis - pathology; Glucocorticoids - therapeutic use; Humans; Hypoalbuminemia - complications; Kidney Failure, Chronic - etiology; Kidney Glomerulus - pathology; Male; Middle Aged; Mycophenolic Acid - therapeutic use; Original; Peroxidase - metabolism; Protective Factors; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; Confidence Intervals; risk factors; Follow-Up Studies; Glucocorticoids; vasculitis; Humans; hypoalbuminemia; Neutrophils; histopathology; Mycophenolic Acid; Antibodies, Antineutrophil Cytoplasmic; kidney; Serum Albumin; ANCA; Biopsy; Kidney Failure, Chronic; Peroxidase; Retrospective Studies; mycophenolate mofetil; glomerulonephritis; Kidney Glomerulus
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.06200616

Our study explored the association of histopathologic classification of ANCA-associated GN with renal survival in Chinese patients with myeloperoxidase-ANCA-associated GN. Two hundred fifteen patients with biopsy-proven myeloperoxidase-ANCA-associated GN were included from January of 1996 to December of 2014. The biopsies included focal ( =27), mixed ( =82), crescentic ( =47), and sclerotic ( =59) classes. The long-term renal outcome and risk factors of myeloperoxidase-ANCA-associated GN for different histopathologic classes were retrospectively analyzed. During a median follow-up time of 22 (9-51) months, 88 (40.9%) patients reached ESRD. The 5-year renal survival (overall 58.7%) was highest in the focal class (100.0%) and lowest in the sclerotic class (20.7%), with no difference between the mixed (58.9%) and crescentic (67.4%) classes. Patients in the mixed (hazard ratio, 0.34; 95% confidence interval, 0.20 to 0.57; <0.001) and crescentic (hazard ratio, 0.31; 95% confidence interval, 0.16 to 0.59; <0.001) classes were at lower risk for ESRD compared with patients in the sclerotic class, as were patients who received glucocorticoids plus mycophenolate mofetil (hazard ratio, 0.32; 95% confidence interval, 0.18 to 0.60; <0.001) compared with those receiving glucocorticoids alone. In addition, patients with a serum creatinine level ≥4 mg/dl (hazard ratio, 2.93; 95% confidence interval, 1.77 to 4.85; <0.001) or hypoalbuminemia (hazard ratio, 2.11; 95% confidence interval, 1.32 to 3.34; =0.002) were at higher risk for ESRD. A serum creatinine level ≥4 mg/dl and a percentage of global sclerotic glomeruli ≥60% were the two independent risk factors for ESRD in the sclerotic class. The histopathologic classification of ANCA-associated GN in combination with serum creatinine and serum albumin levels and treatment regimen is associated with renal outcome in myeloperoxidase-ANCA-associated GN. The evaluation of serum creatinine level and percentage of global sclerotic glomeruli provides additional information on the risk of renal survival in the sclerotic class of myeloperoxidase-ANCA-associated GN.