Combined Activity, Recovery, and Chronicity Kidney Biopsy Grading for Prognostic Assessment in ANCA-associated Vasculitis with Glomerulonephritis (AAV-GN)

E-Poster

https://storage.unitedwebnetwork.com/files/1099/b6755e4e45db907bbeb01595beee91af.pdf

Abstract Title

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Marta

Last Name *

Casal Moura

Co-author 1

Fernando Fervenza Fervenza.Fernando@mayo.edu Mayo Clinic College of Medicine and Science Division of Nephrology and Hypertension, Department of Medicine Rochester

Co-author 2

Ulrich Specks Specks.Ulrich@mayo.edu Mayo Clinic College of Medicine and Science Division of Pulmonary and Critical Care Medicine, Department of Medicine Rochester

Co-author 3

Sanjeev Sethi Sethi.Sanjeev@mayo.edu Mayo Clinic College of Medicine and Science Department of Laboratory Medicine and Pathology Rochester

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Introduction

Previous studies have shown that chronic changes on kidney biopsy are useful for stratifying the risk of kidney failure in patients with AAV-GN. We aimed to evaluate the impact of inflammatory activity for the prediction of renal outcomes.

Methods

A retrospective cohort study of MPO- or PR3-ANCA positive patients with AAV and active renal disease. Inflammatory activity was assessed by the Activity Index (AI): a ratio between the number of crescents and/or necrosis and the total number of glomeruli (in percent). Recovery potential was assessed by the Normal Index (NI): a ratio between the number of normal glomeruli and the total number of glomeruli (in percent). For calculating the combined AAV-GN Combined Score (AAV-GN-CS) we assessed: a) activity: <10%=0;10% – 25%=1; 26%–50%=2; and >50%=3; b) normal (or recovery potential): <10%=3;10%–25%=2;26%–50%=1; and >50% =0. Chronicity was evaluated with the Mayo Clinic Chronicity Score (MCCS). For the combined score, we summed all the components. Our findings were further validated in 132 biopsies.

Results

We analyzed 329 patients with kidney biopsies available to score. The population was classified according with the risk of progression to end-stage kidney disease (ESKD) in 4 classes: minimal (0-5)–107 (32.5%); low (6-11)–140 (42.6%), intermediate (12-14)–52 (15.8%), and high (≥15)–30 (9.1%). Median eGFR at baseline correlated with the overall risk categories: 42.3 vs. 22.0 vs. 15.9 vs. 10.7 mL/min/1.73 m2, p<0.0001. ESKD at 12 months was more frequent in patients at higher risk (50.0% vs. 21.2% vs. 12.9% vs. 4.7%, p<0.0001). The AAV-GN-CS independently predicted the risk of ESDK at 12 months (IRR 1.615, 95%CI 1.189–2.194, p=0.002), particularly increased in patients classified as high risk (IRR 4.406, 95%CI 1.538–12.623, p=0.006) independently of ANCA specificity, IV methylprednisolone, and adjusted for severity of renal involvement and age.

Conclusions

The combined assessment of acute inflammatory activity, recovery potential and chronic changes on kidney histology predicted renal outcomes in patients with AAV-GN.

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