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Medicina 2018, 54(2), 17; https://doi.org/10.3390/medicina54020017

Histopathological Classification—A Prognostic Tool for Rapidly Progressive Glomerulonephritis

1
Centre of Nephrology, Vilnius University Hospital Santaros Klinikos, LT–08661 Vilnius, Lithuania
2
Faculty of Medicine, Vilnius University, LT–03101 Vilnius, Lithuania
*
Author to whom correspondence should be addressed.
Received: 18 February 2018 / Revised: 8 April 2018 / Accepted: 13 April 2018 / Published: 17 April 2018
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Abstract

Background: Recently proposed histopathological classification may predict patient outcome in pauci-immune glomerulonephritis. This study sought to prove that the prognostic effect could be extended to all types of rapidly progressive glomerulonephritis. Methods: Retrospective analysis of patients diagnosed with rapidly progressive glomerulonephritis between April 1999 and August 2015 was performed. Epidemiological and clinical data were collected from medical records. The descriptions of renal biopsies were reviewed and classified into focal, sclerotic, crescentic and mixed class according to classification proposed by Berden et al. The study end points were end stage renal disease (ESRD) or death. Survival analyses were modelled using Cox regression. Results: 73 renal biopsies with diagnosis of rapidly progressive glomerulonephritis were included in the study. 25 (34.2%), 16 (21.9%), 24 (32.9%) and 8 (11%) patients were assigned to focal, crescentic, mixed and sclerotic class, respectively. Thirty-two (42.5%) patients were anti-neutrophil cytoplasmic antibody (ANCA) negative, of which eight (10.9%) were anti–glomerular basement membrane antibody (anti–GBM) positive and 24 (32.8%) were negative for autoimmune antibodies. Six (8.2%) patients died within one year. Among patients who survived, median change in estimated glomerular filtration rate (eGFR) values were: −10.5 mL/min in focal, 4.2 mL/min in crescentic, −4.3 mL/min in mixed and 4.1 mL/min in sclerotic group, p > 0.05. In the Cox regression model, there was no significant predictor of patient survival whereas the sclerotic group (HR 3.679, 95% CI, 1.164–11.628, p < 0.05) and baseline eGFR of <15 mL/min (HR 4.832, 95% CI, 1.55–15.08, p < 0.01) had an unfavorable effect for renal survival. Conclusions: Predominant glomerular sclerosis and low eGFR at baseline are associated with higher risk of ESRD in cases with crescentic glomerulonephritis. Therefore, despite the origin of injury, histological classification might aid in prediction of patient outcomes in rapidly progressive glomerulonephritis. View Full-Text
Keywords: rapidly progressive glomerulonephritis; crescentic glomerulonephritis; ANCA associated glomerulonephritis; histopathological classification; renal outcome rapidly progressive glomerulonephritis; crescentic glomerulonephritis; ANCA associated glomerulonephritis; histopathological classification; renal outcome
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Kantauskaitė, M.; Laučytė-Cibulskienė, A.; Miglinas, M. Histopathological Classification—A Prognostic Tool for Rapidly Progressive Glomerulonephritis. Medicina 2018, 54, 17.

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