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Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Kidney Research and Clinical Practice 2021년 40권 1호 p.77 ~ 88
임정훈, 한만훈, 김용진, 전예나, 정희연, 최지영, 조장희, 김찬덕, 김용림, 이하정, 김동기, 문경철, 박선희,
소속 상세정보
임정훈 ( Lim Jeong-Hoon ) - Kyungpook National University School of Medicine Department of Internal Medicine
한만훈 ( Han Man-Hoon ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Pathology
김용진 ( Kim Yong-Jin ) - Kyungpook National University School of Medicine Kyungpook National University Hospital Department of Pathology
전예나 ( Jeon Ye-Na ) - Kyungpook National University Department of Statistics
정희연 ( Jung Hee-Yeon ) - Kyungpook National University School of Medicine Department of Internal Medicine
최지영 ( Choi Ji-Young ) - Kyungpook National University School of Medicine Department of Internal Medicine
조장희 ( Cho Jang-Hee ) - Kyungpook National University School of Medicine Department of Internal Medicine
김찬덕 ( Kim Chan-Duck ) - Kyungpook National University School of Medicine Department of Internal Medicine
김용림 ( Kim Yong-Lim ) - Kyungpook National University School of Medicine Department of Internal Medicine
이하정 ( Lee Ha-Jeong ) - Seoul National University College of Medicine Department of Internal Medicine
김동기 ( Kim Dong-Kie ) - Seoul National University College of Medicine Department of Internal Medicine
문경철 ( Moon Kyung-Chul ) - Seoul National University College of Medicine Department of Pathology
박선희 ( Park Sun-Hee ) - Kyungpook National University School of Medicine Department of Internal Medicine

Abstract


Background: Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) is a common cause of rapidly progressive glomerulonephritis and requires prompt and proper immunosuppressive therapy to improve renal prognosis. This study aimed to evaluate the predictive value of two different classifications for renal outcomes in Korean AAGN patients.

Methods: Ninety-two patients who were diagnosed with AAGN at two tertiary hospitals between 2004 and 2018 were retrospectively analyzed retrospectively. The histopathologic classification according to glomerular pathology and the clinicopathologic classification according to normal glomeruli ratio, degree of interstitial fibrosis/tubular atrophy, and baseline renal function were evaluated using the Cox proportional hazards model.

Results: Forty-five patients (48.9%) progressed to end-stage kidney disease (ESKD) during the observation period. The mean age was 61.0 ± 15.3 years, and most patients had myeloperoxidase-ANCA (93.5%). In the histopathologic classification, the best renal survival occurred in the focal class, whereas the sclerotic class had the worst renal survival (sclerotic class vs. focal class; adjusted hazard ratio [aHR], 5.05; 95% confidence interval [CI], 1.32-19.31; p = 0.018). The mixed class had intermediate renal outcomes (mixed class vs. focal class; aHR, 4.23; 95% CI, 1.23-14.58; p = 0.022). In the clinicopathologic classification, the high-risk group had poor renal outcomes compared with the low-risk group (aHR, 6.56; 95% CI, 1.25-34.26; p = 0.026), but renal outcomes did not differ between the low- and medium-risk groups.

Conclusion: In Korean AAGN patients, histopathologic and clinicopathologic classifications had predictive value for renal outcomes, especially in the sclerotic class or the high-risk group with higher risk of progression to ESKD despite treatment.

키워드

Antibodies; Antineutrophil cytoplasmic; Classification; Glomerulonephritis; Kidney failure; Chronic; Pathology

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