Validation of a newly proposed histopathological classification in Japanese patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis

BMC Nephrology

Yujiro Asada⁸  Kazuo Kitamura⁹  Takashi Wada³  Takeshi Tokura⁶  Shuichi Hisanaga⁷  Yoshiya Shimao¹  Shigehiro Uezono^1,10  Atsushi Yamashita⁸  Yunosuke Matsuura⁸  Junya Yamahana⁴  Kengo Furuichi²  Kiyoki Kitagawa²  Shouichi Fujimoto⁵  Takashi Iwakiri⁸ 

[1] Department of Pathology, Miyazaki Prefectural Hospital, Miyazaki, Japan;Division of Blood Purification, Kanazawa University Hospital, Kanazawa, Japan;Division of Nephrology, Department of Laboratory Medicine, Kanazawa University, Kanazawa, Japan;Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan;Department of Hemovascular Medicine and Artificial Organs, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan;Department of Internal Medicine, Miyazaki Social Insurance Konan Hospital, Miyazaki, Japan;Department of Internal Medicine, Koga General Hospital, Miyazaki, Japan;Department of Pathology, University of Miyazaki, Miyazaki, Japan;Division of Circulation and Body Fluid Regulation, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan;Department of Internal Medicine, Miyazaki Prefectural Hospital, Miyazaki, Japan

关键词: α-Smooth muscle actin;    Immunohistochemistry;    Histopathological classification;    Anti-neutrophil cytoplasmic antibody;   

Others  :  1082914
DOI  :  10.1186/1471-2369-14-125

 received in 2012-07-23, accepted in 2013-06-12,  发布年份 2013

【 摘 要 】

Background

A new histopathological classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis was recently proposed. We evaluated the predictive value of this classification for renal outcome in Japanese patients.

Methods

We enrolled 122 patients with ANCA-associated glomerulonephritis diagnosed at several institutions in Japan between January 2000 and March 2010. Twenty patients were excluded because of observation durations of <1 year, and/or because their biopsy specimens contained <10 glomeruli. Renal biopsy specimens were categorized into four classes according to the proposed classification. We evaluated the predictive value of immunohistochemical staining for α-smooth muscle actin (SMA), Wilm’s tumor 1 (WT1), CD68, and cytokeratin for end-stage renal disease (ESRD).

Results

The study population included 54 men and 48 women. Age, estimated glomerular filtration rate (eGFR), and proteinuria were 66.3 ± 11.3 years, 21.6 ml/min. and 1.10 g/24 h, respectively. Eighty-six patients were positive for myeloperoxidase-ANCA, five were positive for proteinase 3-ANCA, and 11 were negative for both antibodies. Median follow-up time was 41.0 months. Twenty-three patients (22.5%) developed ESRD during the follow-up period. Twelve patients died during follow up; 7/12 patients developed ESRD before death, and 5/12 patients died without ESRD. The incidence of ESRD increased with sequential categories: focal, 2/46 (4.3%); crescentic, 9/32 (28%); mixed, 8/18 (44%); and sclerotic, 4/6 (67%). The focal class had the best renal survival and the sclerotic class had the worst renal survival (p < 0.001). Kaplan-Meier renal survival analysis was similar to that of the new classification system proposal. In the multivariate analysis, the classification system tended to be a prognostic factor for ESRD (p = 0.0686, crescentic, mixed and sclerotic vs. focal, hazard ratio (HR) [95% confidence interval, CI]; 2.99 [0.61–22.7], 5.04 [1.11–36.4] and 9.93 [1.53–85.7], respectively). α-SMA-positivity also tended to be associated with ESRD (p = 0.1074).

Conclusion

The new histopathological classification was associated with eGFR at 1 year and tended to be associated with ESRD in our Japanese cohort with ANCA-associated glomerulonephritis. α-SMA positivity might be an additional prognostic factor for ESRD.

【 授权许可】

   
2013 Iwakiri et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 5.

Figure 2.

Figure 3.

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