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

• Published in: International urology and nephrology Vol. 55; no. 3; pp. 741 - 748
• Main Authors: Aydın, Mehmet Fethullah, Yıldız, Abdülmecit, Oruç, Ayşegül, Aytaç Vuruşkan, Berna, Akgür, Suat, Ayar, Yavuz, Güllülü, Mustafa, Dilek, Kamil, Yavuz, Mahmut, Ortaç, Hatice, Ersoy, Alparslan
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01-03-2023; Springer Nature B.V
• Subjects: Age; Antineutrophil cytoplasmic antibodies; Classification; Creatinine; Glomerulonephritis; Kidneys; Medicine; Medicine & Public Health; Nephrology; Nephrology - Original Paper; Regression analysis; Statistical analysis; Statistical significance; Statistics; Survival; Survival analysis; Urology; Anti-neutrophil cytoplasmic antibodies; Histopathological classification; Age-related glomerulosclerosis; ANCA; ANCA-associated vasculitis; Renal pathology
• ISSN: 1573-2584; 0301-1623; 1573-2584
• DOI: 10.1007/s11255-022-03371-6

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.