Skip to main content

Advertisement

Log in

Modified histopathological classification with age-related glomerulosclerosis for predicting kidney survival in ANCA-associated glomerulonephritis

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Background

The histopathological classification of ANCA-GN divides patients into four groups based on signs of glomerular injury. However, this classification did not consider age-related glomerulosclerosis. In this study, we aimed to compare the prediction of renal survival between Berden's ANCA-GN histopathological classification and ANCA-GN histopathological classification modified with age-related glomerulosclerosis.

Methods

Between January 2004 and December 2019, 65 patients diagnosed with ANCA-GN were enrolled. Demographic, laboratory, and histopathologic findings were retrospectively analyzed. Renal survival analyses were compared according to classical and modified ANCA-GN histopathological classifications. Multivariate Cox regression analysis for the factors affecting renal survival was performed.

Results

In Berden's ANCA-GN histopathological classification, 15 patients were in the focal group, 21 in the crescentic, 21 in the sclerotic, and 8 in the mixed group. The ANCA-GN histopathological classification model generated statistically significant predictions for renal survival (p = 0.022). When the histopathological classification was modified with age-related glomerulosclerosis, eight of the nine patients previously classified in the sclerotic group were classified in the mixed and one in the crescentic groups. Modification of histopathological classification with age-related glomerulosclerosis increases the statistical significance in renal survival analysis (p = 0.009). The multivariate Cox regression analysis showed that the disease-related global sclerotic glomeruli percentage and serum creatinine level were significant independent factors.

Conclusion

Modification of Berden's ANCA-GN histopathological classification model with age-related glomerulosclerosis may increase the statistical significance of the histopathological classification model.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jennette JC, Falk RJ, Bacon PA et al (2013) 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 65:1–11. https://doi.org/10.1002/art.37715

    Article  CAS  PubMed  Google Scholar 

  2. Geetha D, Jefferson JA (2020) ANCA-associated vasculitis: core curriculum 2020. Am J Kidney Dis 75:124–137. https://doi.org/10.1053/j.ajkd.2019.04.031

    Article  CAS  PubMed  Google Scholar 

  3. Jennette JC, Nachman PH (2017) ANCA glomerulonephritis and vasculitis. Clin J Am Soc Nephrol 12:1680–1691. https://doi.org/10.2215/CJN.02500317

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jennette JC, Falk RJ (2019) Renal and systemic vasculitis. In: Feehally J, Floege J, Tonelli M, Johnson RJ (eds) Comprehensive clinical nephrology, 6th edn. Elsevier, pp 290–305

    Google Scholar 

  5. Berden AE, Ferrario F, Hagen EC et al (2010) Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628–1636. https://doi.org/10.1681/ASN.2010050477

    Article  PubMed  Google Scholar 

  6. Nohr E, Girard L, James M, Benediktsson H (2014) Validation of a histopathologic classification scheme for antineutrophil cytoplasmic antibody-associated glomerulonephritis. Hum Pathol 45:1423–1429. https://doi.org/10.1016/j.humpath.2014.02.017

    Article  PubMed  Google Scholar 

  7. Quintana LF, Peréz NS, De Sousa E et al (2014) ANCA serotype and histopathological classification for the prediction of renal outcome in ANCA-associated glomerulonephritis. Nephrol Dial Transplant 29:1764–1769. https://doi.org/10.1093/ndt/gfu084

    Article  CAS  PubMed  Google Scholar 

  8. Togashi M, Komatsuda A, Nara M et al (2014) Validation of the 2010 histopathological classification of ANCA-associated glomerulonephritis in a Japanese single-center cohort. Mod Rheumatol 24:300–303. https://doi.org/10.3109/14397595.2013.854068

    Article  PubMed  Google Scholar 

  9. Muso E, Endo T, Itabashi M et al (2013) Evaluation of the newly proposed simplified histological classification in Japanese cohorts of myeloperoxidase-anti-neutrophil cytoplasmic antibody-associated glomerulonephritis in comparison with other Asian and European cohorts. Clin Exp Nephrol 17:659–662. https://doi.org/10.1007/s10157-012-0755-7

    Article  CAS  PubMed  Google Scholar 

  10. You X, Zhang J, Ding X et al (2021) Predictors of renal outcomes in crescentic and mixed class of ANCA-associated glomerulonephritis. Clin Nephrol 95:81–86. https://doi.org/10.5414/CN110221

    Article  PubMed  Google Scholar 

  11. Chen Y-X, Xu J, Pan X-X et al (2017) Histopathological classification and renal outcome in patients with antineutrophil cytoplasmic antibodies-associated renal vasculitis: a study of 186 patients and metaanalysis. J Rheumatol 44:304–313. https://doi.org/10.3899/jrheum.160866

    Article  PubMed  Google Scholar 

  12. Huang S, Shen Q, Yang R et al (2018) An evaluation of the 2010 histopathological classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis: a Bayesian network meta-analysis. Int Urol Nephrol 50:1853–1861. https://doi.org/10.1007/s11255-018-1941-7

    Article  CAS  PubMed  Google Scholar 

  13. Tanna A, Guarino L, Tam FWK et al (2015) Long-term outcome of anti-neutrophil cytoplasm antibody-associated glomerulonephritis: evaluation of the international histological classification and other prognostic factors. Nephrol Dial Transplant 30:1185–1192. https://doi.org/10.1093/ndt/gfu237

    Article  CAS  PubMed  Google Scholar 

  14. Hilhorst M, Wilde B, van Breda VP et al (2013) Estimating renal survival using the ANCA-associated GN classification. J Am Soc Nephrol 24:1371–1375. https://doi.org/10.1681/ASN.2012090912

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bjørneklett R, Sriskandarajah S, Bostad L (2016) Prognostic value of histologic classification of ANCA-associated glomerulonephritis. Clin J Am Soc Nephrol 11:2159–2167. https://doi.org/10.2215/CJN.04800516

    Article  PubMed  PubMed Central  Google Scholar 

  16. van Daalen EE, Wester Trejo MAC, Göçeroğlu A et al (2020) Developments in the histopathological classification of ANCA-associated glomerulonephritis. Clin J Am Soc Nephrol 15:1103–1111. https://doi.org/10.2215/CJN.14561119

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tracy RE, Ishii T (2000) What is “nephrosclerosis”? lessons from the US, Japan, and Mexico. Nephrol Dial Transplant 15:1357–1366. https://doi.org/10.1093/ndt/15.9.1357

    Article  CAS  PubMed  Google Scholar 

  18. Rule AD, Amer H, Cornell LD et al (2010) The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann Intern Med 152:561–567. https://doi.org/10.7326/0003-4819-152-9-201005040-00006

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kasiske BL (1987) Relationship between vascular disease and age-associated changes in the human kidney. Kidney Int 31:1153–1159. https://doi.org/10.1038/ki.1987.122

    Article  CAS  PubMed  Google Scholar 

  20. Anderson S, Brenner BM (1986) Effects of aging on the renal glomerulus. Am J Med 80:435–442. https://doi.org/10.1016/0002-9343(86)90718-7

    Article  CAS  PubMed  Google Scholar 

  21. Kremers WK, Denic A, Lieske JC et al (2015) Distinguishing age-related from disease-related glomerulosclerosis on kidney biopsy: the Aging Kidney Anatomy study. Nephrol Dial Transplant 30:2034–2039. https://doi.org/10.1093/ndt/gfv072

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhang J, Hansen KM, Pippin JW et al (2012) De novo expression of podocyte proteins in parietal epithelial cells in experimental aging nephropathy. Am J Physiol Renal Physiol 302:F571–F580. https://doi.org/10.1152/ajprenal.00516.2011

    Article  CAS  PubMed  Google Scholar 

  23. Wharram BL, Goyal M, Wiggins JE et al (2005) Podocyte depletion causes glomerulosclerosis: diphtheria toxin-induced podocyte depletion in rats expressing human diphtheria toxin receptor transgene. J Am Soc Nephrol 16:2941–2952. https://doi.org/10.1681/ASN.2005010055

    Article  CAS  PubMed  Google Scholar 

  24. Brix SR, Noriega M, Tennstedt P et al (2018) Development and validation of a renal risk score in ANCA-associated glomerulonephritis. Kidney Int 94:1177–1188. https://doi.org/10.1016/j.kint.2018.07.020

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mehmet Fethullah Aydın.

Ethics declarations

Conflicts of interest

The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2016-5/6) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aydın, M.F., Yıldız, A., Oruç, A. et al. Modified histopathological classification with age-related glomerulosclerosis for predicting kidney survival in ANCA-associated glomerulonephritis. Int Urol Nephrol 55, 741–748 (2023). https://doi.org/10.1007/s11255-022-03371-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-022-03371-6

Keywords

Navigation