Long-term outcome of anti-neutrophil cytoplasm antibody-associated XXXX : evaluation of the international histological classification and other prognostic factors.

@entity1 @entity8 @entity3335 @entity1333 @entity3808 @entity194 @entity631
BACKGROUND: Anti-neutrophil cytoplasm antibody (ANCA) associated @entity1333 with @entity8 requires treatment with potentially toxic drugs to reduce morbidity and mortality, and there is a major challenge to determine clinical and histological features predictive of renal prognosis. The aim of our study was to evaluate the use of the 2010 international histological classification for ANCA-associated @entity631 (AAGN) as a predictor of renal outcome when used in conjunction with other prognostic factors. METHODS: One hundred and four @entity1 with AAGN treated at our centre were included: 23 were classified as focal, 26 as crescentic, 48 as mixed and 7 as @entity3808 . Renal outcomes were based on estimated glomerular filtration rate (eGFR) at 1 and 5 years, and on renal survival. RESULTS: By univariate analysis, @entity1 in the focal class had the best renal outcome, those in the @entity3808 class the worst outcome, and those in the mixed and crescentic classes had intermediate renal survival. There was no significant difference in outcome between the mixed and crescentic classes. In multivariate models, histological class did not improve model fit or associate with renal outcome after adjusting for established prognostic factors. Lower percentage of normal glomeruli, greater degree of @entity194 ( @entity194 ), @entity3335 -ANCA positivity, increasing age and lower starting eGFR, all correlated with poorer renal outcomes. CONCLUSIONS: We conclude that, in our cohort of @entity1 , the international histological classification is predictive of renal outcome in AAGN, but did not appear to be additionally informative over other established prognostic factors in multivariate analysis. However, it may be of value to combine the current histological classification with other established parameters, such as @entity194 and percentage normal glomeruli.
