Predicting Outcome in Patients with Anti-GBM Glomerulonephritis
Copyright © 2018 by the American Society of Nephrology..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 13(2018), 1 vom: 06. Jan., Seite 63-72 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
van Daalen, Emma E [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 16.07.2019 Date Revised 13.08.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.2215/CJN.04290417 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM278287050 |
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| 100 | 1 | |a van Daalen, Emma E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Predicting Outcome in Patients with Anti-GBM Glomerulonephritis |
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| 500 | |a Date Completed 16.07.2019 | ||
| 500 | |a Date Revised 13.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 by the American Society of Nephrology. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_11_21_CJASNPodcast_18_1_v.mp3 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a ANCA | |
| 650 | 4 | |a Antibodies, Antineutrophil Cytoplasmic | |
| 650 | 4 | |a Autoantibodies | |
| 650 | 4 | |a Biopsy | |
| 650 | 4 | |a Confidence Intervals | |
| 650 | 4 | |a Follow-Up Studies | |
| 650 | 4 | |a Glomerular Basement Membrane | |
| 650 | 4 | |a Goodpasture-s syndrome | |
| 650 | 4 | |a Kidney Failure, Chronic | |
| 650 | 4 | |a Multivariate Analysis | |
| 650 | 4 | |a Regression Analysis | |
| 650 | 4 | |a Retrospective Studies | |
| 650 | 4 | |a Survival Rate | |
| 650 | 4 | |a anti-GBM disease | |
| 650 | 4 | |a antiglomerular basement membrane antibody | |
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| 650 | 4 | |a renal dialysis | |
| 650 | 7 | |a Autoantibodies |2 NLM | |
| 650 | 7 | |a antiglomerular basement membrane antibody |2 NLM | |
| 700 | 1 | |a Jennette, J Charles |e verfasserin |4 aut | |
| 700 | 1 | |a McAdoo, Stephen P |e verfasserin |4 aut | |
| 700 | 1 | |a Pusey, Charles D |e verfasserin |4 aut | |
| 700 | 1 | |a Alba, Marco A |e verfasserin |4 aut | |
| 700 | 1 | |a Poulton, Caroline J |e verfasserin |4 aut | |
| 700 | 1 | |a Wolterbeek, Ron |e verfasserin |4 aut | |
| 700 | 1 | |a Nguyen, Tri Q |e verfasserin |4 aut | |
| 700 | 1 | |a Goldschmeding, Roel |e verfasserin |4 aut | |
| 700 | 1 | |a Alchi, Bassam |e verfasserin |4 aut | |
| 700 | 1 | |a Griffiths, Meryl |e verfasserin |4 aut | |
| 700 | 1 | |a de Zoysa, Janak R |e verfasserin |4 aut | |
| 700 | 1 | |a Vincent, Beula |e verfasserin |4 aut | |
| 700 | 1 | |a Bruijn, Jan A |e verfasserin |4 aut | |
| 700 | 1 | |a Bajema, Ingeborg M |e verfasserin |4 aut | |
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