PT  - JOURNAL ARTICLE
AU  - Yong-Xi Chen
AU  - Jing Xu
AU  - Xiao-Xia Pan
AU  - Ping-Yan Shen
AU  - Xiao Li
AU  - Hong Ren
AU  - Xiao-Nong Chen
AU  - Li-Yan Ni
AU  - Wen Zhang
AU  - Nan Chen
TI  - Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis
AID  - 10.3899/jrheum.160866
DP  - 2016 Dec 15
TA  - The Journal of Rheumatology
PG  - jrheum.160866
4099  - http://www.jrheum.org/content/early/2016/12/08/jrheum.160866.short
4100  - http://www.jrheum.org/content/early/2016/12/08/jrheum.160866.full
AB  - Objective Renal vasculitis is one of the most common manifestations of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) and renal histology is a key predictor of the outcome. A new histopathologic classification was proposed and validated, but the results are still debated. Methods We performed a retrospective analysis to validate the histopathologic classification and performed a metaanalysis to evaluate its predictive value. There were 186 patients with ANCA-associated renal vasculitis diagnosed at Ruijin Hospital who were enrolled in the retrospective study. The metaanalysis considered the data for 1601 patients. Results In our retrospective study, patients with focal class had the best renal outcome while patients with mixed class had the worst (p < 0.001). Metaanalysis showed that patients with focal class had better renal outcome than did those with crescentic class [risk ratio (RR) 0.23, 95% CI 0.16–0.34, p < 0.00001], with no evidence of heterogeneity (I2 = 0%, p = 0.96). Patients with crescentic class had better renal outcome than did those with sclerotic class (RR 0.52, 95% CI 0.41–0.64, p < 0.00001), with no evidence of heterogeneity (I2 = 2%, p = 0.43). We did not find statistical significance regarding renal outcome between mixed and crescentic classes (RR 1.14, 95% CI 0.91–1.43, p = 0.27), with no evidence of heterogeneity (I2 = 23%, p = 0.19). The retrospective study showed that lung and upper respiratory tract involvement were the most common extrarenal manifestations. Conclusion We demonstrated the clinical utility of histopathologic classification in determining renal outcome in patients with AAV. Metaanalysis showed that patients with focal class had the best outcome while sclerotic class had the worst.