Journal
CLINICAL RHEUMATOLOGY
Volume 40, Issue 12, Pages 5009-5017Publisher
SPRINGER LONDON LTD
DOI: 10.1007/s10067-021-05862-w
Keywords
ANCA-associated glomerulonephritis; Clinicopathological manifestation; The renal risk score; Outcome
Categories
Funding
- National Natural Science Foundation of China [81970628]
- Science and Technology Development Plan Project of Jilin province [20200201488JC, 20190304042YY]
- Jilin Province Sanitation and Health Technology Innovation Project [2018J048]
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The renal risk score is an effective predictor for end-stage renal disease (ESRD) in Chinese AAGN patients, particularly in the high-risk group with worse renal outcomes. This score could potentially help stratify patients for appropriate management and intervention strategies.
Introduction In 2018, a renal risk score of antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (AAGN) based on estimated glomerular filtration rate (eGFR), normal glomeruli, and tubular atrophy/interstitial fibrosis (TA/IF) was proposed to predict renal outcomes. We aimed to evaluate this renal risk score in a myeloperoxidase (MPO)-ANCA predominant population in Northeast China. Methods We retrospectively analyzed the clinicopathologic data of 65 patients biopsy-proven from a Chinese medical center. Each patient was assessed by eGFR, normal glomeruli, and TA/IF, and the renal outcome was evaluated using the renal risk score. Results In our study, 95.4% of patients were ANCA positive (78.5% MPO-ANCA positive and 16.9% proteinase 3-ANCA positive). The average follow-up period was 14.3 months. Thirty-four patients (52.3%) reached end-stage renal disease (ESRD). Based on the renal risk score, 8 (12.3%), 31 (47.7%), and 26 (40%) patients were divided into the low-risk, medium-risk, and high-risk groups, respectively. Kaplan-Meier survival curves revealed the high-risk group had worse renal outcomes than the low-risk group (p<0.01) and the medium-risk group (p<0.01), but the renal outcome did not differ between the low-risk and medium-risk groups (p>0.017). Similar results were obtained by the competitive survival analysis. The AUC for 3-year overall ESRD predictions was 0.845. In the regression analysis, the renal risk score was a favorable predictor for the development of ESRD (HR 3.13, 95%CI 1.58-6.19, p=0.001). Conclusion The renal risk score is a preferred index that can predict ESRD in Chinese AAGN patients, especially in the high-risk group with worse renal outcomes.
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