Elsevier

Kidney International

Volume 56, Issue 5, November 1999, Pages 1751-1758
Kidney International

Cell Biology – Immunology – Pathology
Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis

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Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis.

Background

In kidney biopsies of patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis, a variety of histopathological lesions occur, and their relationship to renal outcome is virtually unknown. This multicenter European study reports a clinicopathological analysis of biopsies from 157 patients with systemic vasculitis.

Methods

The biopsies were evaluated according to a previously standardized scoring protocol. Serum creatinine values were measured at the time of biopsy and one year later. In addition, the lowest creatinine level during follow-up was taken into account as the optimum level of renal function recovery. The clinical prognostic value of the histopathological parameters was analyzed with the Kruskal–Wallis one-way analysis of variance and the Mann–Whitney U-test.

Results

The percentage of normal glomeruli correlated most significantly with renal outcome at all points of measurement (all P < 0.001). Other lesions predicting for renal function were glomerular sclerosis (P < 0.0005 at one year after the biopsy), diffuse interstitial infiltrates (P < 0.0001 at entry, P < 0.0003 at one year), tubular necrosis (P < 0.0025 at entry), and tubular atrophy (P < 0.002 at entry, P < 0.0002 at one year).

Conclusion

Traditionally, attention is focused on the extent of active lesions in the renal biopsy in order to determine the severity of renal disease and its implication for renal outcome. Because of their significant impact on renal function, combined with their easy recognition, we recommend the use of the percentage of normal glomeruli in an adequate biopsy in predicting renal function of patients with systemic vasculitis.

Keywords

renal biopsy
systemic vasculitis
tubular necrosis
ANCA
fibrinoid necrosis
rapidly progressive glomerulonephritis

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1

The following investigators participated in the European Commission/Bureau Communautaire de Référence (EC/BCR) Study for ANCA-Assay Standardisation: Study Coordinators. E.C. Hagen, F.J. van der Woude, and M.R. Daha (Leiden University Medical Center, Leiden, The Netherlands). Steering Committee. G. Gaskin and C.D. Pusey (Hammersmith Hospital, London, UK), K. Andrassy (University of Heidelberg, Heidelberg, Germany), N. Rasmussen (Rigshospitalet, Copenhagen, Denmark), A. Wiik (Statens Serum Institut, Copenhagen, Denmark), F. Ferrario and R.A. Sinico (San Carlo Borromeo Hospital, Milan, Italy), Z. Heigl (Karolinska Institute, Stockholm, Sweden), D. Jayne and C.M. Lockwood (Addenbrooke's Hospital, Cambridge, UK), C.G.M. Kallenberg and J.W. Cohen Tervaert (University Hospital Groningen, Groningen, The Netherlands), Ph. Lesavre (Hôpital Necker, Paris, France), J. Lüdemann (Utecht and Lüdemann, Klausdorf, Germany), F. Mascart-Lemone (Hôpital Erasme, Brussels, Belgium), E. Mirapeix (Hospital Clinic I Provincial, Barcelona, Spain), A. Tzioufas (National University of Athens, Athens, Greece), J. Wieslander (Wieslab AB, Lund, Sweden), and K. de Groot and W.L. Gross (University of Lübeck, Bad Bramstedt, Germany). Pathology Review. (Renal biopsies): I.M. Bajema and J.A. Bruijn (Leiden University Medical Center, Leiden, The Netherlands), L.H. Noël (Hôpital Necker, Paris, France), R. Waldherr (University of Heidelberg, Heidelberg, Germany), and F. Ferrario (San Carlo Borromeo Hospital, Milan, Italy). (Respiratory tract biopsies): B. Ravn Juhl and C.B. Andersen (Rigshospitalet, Copenhagen, Denmark). Statistical Analysis. J. Hermans and B.E. Hansen (Leiden University Medical Center, Leiden, The Netherlands). Data Management. M.J.K. Mallat (Leiden University Medical Center, Leiden, The Netherlands). Participating Investigators. E. Csernok (Rheumaklinik Bad Bramstedt, University of Lübeck, Bad Bramstedt, Germany), M. de Waele (Academisch Ziekenhuis Vrije Universiteit, Brussels, Belgium), W. Szpirt and J. Petersen (Rigshospitalet, Copenhagen, Denmark), C. Geffriaud (Hôpital Necker, Paris, France), G. Gregorini (Ple Spedali Civili, Brescia, Italy), M. Quarenghi (Ospedale S. Anna, Como, Italy), A. Lopez Soto (Hospital Clinic I Provincial, Barcelona, Spain), E. Pettersson (Huddinge University Hospital, Huddinge, Sweden), J. Berglund, T. Zweig and S. Jacobson (Karolinska Institute, Stockholm, Sweden), P. Chapman (Addenbrooke's Hospital, Cambridge, UK). Other Support. (Technical assistance). E. Heemskerk (Leiden University Medical Center, Leiden, The Netherlands), A. Radice (San Carlo Borromeo Hospital, Milan, Italy), J.M. Flodman (Karolinska Institute, Stockholm, Sweden), and A. Coulthart (Hammersmith Hospital, London, UK). (Provided biopsy material) M. Thompson (Hammersmith Hospital, London, UK) and S. Thiru (Addenbrooke's Hospital, Cambridge, UK).