Predicting Outcome in Patients with Anti-GBM Glomerulonephritis.
Clin J Am Soc Nephrol
; 13(1): 63-72, 2018 01 06.
Article
en En
| MEDLINE
| ID: mdl-29162595
ABSTRACT
BACKGROUND AND OBJECTIVES:
Large studies on long-term kidney outcome in patients with anti-glomerular basement membrane (anti-GBM) GN are lacking. This study aimed to identify clinical and histopathologic parameters that predict kidney outcome in these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective analysis included a total of 123 patients with anti-GBM GN between 1986 and 2015 from six centers worldwide. Their kidney biopsy samples were classified according to the histopathologic classification for ANCA-associated GN. Clinical data such as details of treatment were retrieved from clinical records. The primary outcome parameter was the occurrence of ESRD. Kidney survival was analyzed using the log-rank test and Cox regression analyses.RESULTS:
The 5-year kidney survival rate was 34%, with an improved rate observed among patients diagnosed after 2007 (P=0.01). In patients with anti-GBM GN, histopathologic class and kidney survival were associated (P<0.001). Only one of 15 patients with a focal class biopsy sample (≥50% normal glomeruli) developed ESRD. Patients with a sclerotic class biopsy sample (≥50% globally sclerotic glomeruli) and patients with 100% cellular crescents did not recover from dialysis dependency at presentation. In multivariable analysis, dialysis dependency at presentation (hazard ratio [HR], 3.17; 95% confidence interval [95% CI], 1.59 to 6.32), percentage of normal glomeruli (HR, 0.97; 95% CI, 0.95 to 0.99), and extent of interstitial infiltrate (HR, 2.02; 95% CI, 1.17 to 3.50) were predictors of ESRD during follow-up.CONCLUSIONS:
Dialysis dependency, low percentage of normal glomeruli, and large extent of interstitial infiltrate are associated with poor kidney outcome in anti-GBM GN. Kidney outcome has improved during recent years; the success rate doubled after 2007. PODCAST This article contains a podcast at https//www.asn-online.org/media/podcast/CJASN/2017_11_21_CJASNPodcast_18_1_v.mp3.Palabras clave
ANCA; Antibodies, Antineutrophil Cytoplasmic; Autoantibodies; Biopsy; Confidence Intervals; Follow-Up Studies; Glomerular Basement Membrane; Goodpasture-s syndrome; Kidney Failure, Chronic; Multivariate Analysis; Regression Analysis; Retrospective Studies; Survival Rate; anti-GBM disease; antiglomerular basement membrane antibody; glomerulonephritis; kidney; kidney biopsy; renal dialysis
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Autoanticuerpos
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Membrana Basal
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Enfermedad por Anticuerpos Antimembrana Basal Glomerular
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Glomérulos Renales
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Clin J Am Soc Nephrol
Asunto de la revista:
NEFROLOGIA
Año:
2018
Tipo del documento:
Article