Predictors of renal outcomes in crescentic and mixed class of ANCA-associated glomerulonephritis

Background: The aim of this study was to investigate the predictors of renal outcomes in crescentic and mixed class of ANCA-associated glomerulonephritis. Materials and methods: We systematically reviewed the medical records of patients with ANCA-associated glomerulonephritis admitted to our hospital from December 2008 to December 2018, and found 30 patients with crescentic and 40 patients with mixed ANCA-associated glomerulonephritis. Results: End-stage renal disease developed in 33.3 and 25% patients over a median follow-up of 45.1 and 46.7 months in the crescentic and mixed group, respectively. There was no significant difference in renal survival rates between the two histological subgroups (log-rank p = 0.558). In the Cox regression model, old age, lower estimated glomerular filtration rate (eGFR), lower normal glomeruli ratio, and a higher tubular atrophy and interstitial fibrosis ratio were significantly associated end-stage renal disease (p < 0.05 for all). Among our patients, 17.1% were at low risk, 57.1% were at medium risk, and 25.7% were at high risk according to antineutrophil cytoplasmic antibody renal risk score and end-stage renal disease developed in 8.3, 40, and 66.7%, respectively (p = 0.024). Conclusion: These findings indicated that the renal risk score was a better prognostic tool than Berden's classification in a cohort with crescentic and mixed histologic categories.

Automated summary

This study investigated predictors of renal outcomes in crescentic and mixed class of ANCA-associated glomerulonephritis, finding that old age, lower eGFR, lower normal glomeruli ratio, and higher tubular atrophy and interstitial fibrosis ratio were significantly associated with end-stage renal disease. The antineutrophil cytoplasmic antibody renal risk score was found to be a better prognostic tool than Berden's classification in predicting outcomes in these patients.