Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: Histologic correlates with outcomes in ANCA associated glomerulonephritis (ANCA-GN) based on IWGRP class are limited to findings on initial biopsy. Analysis of the evolution of these changes over time would lead to better understanding of salvageable lesions. Methods: Cases of ANCA-GN diagnosed from 1996 to 2017 with at least one follow up biopsy were identified. Clinical data at the time of initial (RB1) and follow up (RB2) biopsy were collected. Biopsies were categorized as Focal, Crescentic, Mixed, or Sclerotic (IWGRP classification for AAV-GN) based on original pathology reports. Results: Twenty four patients (mean age: 67 years, 58% females, 87% Caucasian, 63%p-ANCA, 25% c-ANCA) had RB2 at a mean of 44 months after RB1. RB2 was performed for suspected relapse (n = 16), persistent hematuria (n = 3), worsening proteinuria (n = 3) and CKD (n = 2). Most cases were classified on RB1 as Focal (n = 8) or Mixed (n = 10), and showed mixed progression, with 2 Focal remaining Focal and 1 becoming mixed and 1 becoming Sclerotic, the remaining 3 did not show active GN; among the Mixed cases 3 were classified as Focal and 1 was classified Sclerotic on RB2, the remaining 6 did not show active GN. Among 8 patients who reached ESRD at a mean of 24 months post RB2, 5 patients did not have active GN, 1 progressed to Sclerotic and 2 were classified as Focal class on RB2. Although Crescentic cases demonstrated the lowest mean % global glomerulosclerosis (GS) at RB1, they showed greater progression to GS at RB2 when compared to Focal cases (Figure 1). Conclusion: All classes at initial biopsy showed progression to ESRD. The IWGRP class changes seen in follow up biopsy suggests that some active lesions revert to normal phenotype with therapy while others progress to a chronic pattern. Disclosures: None Mean %Global GS at RB1 and RB2 based
Source: Lara D. Veeken
Institutions: Johns Hopkins University, Johns Hopkins Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2933720124