For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
0
views
18
references
 Top references
cited by
0
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      92
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Evaluation of the Risk Prediction Models in Predicting Kidney Outcomes in Antiglomerular Basement Membrane Disease

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Introduction

          A previous study showed that the renal risk score (RRS) was transferrable to antiglomerular basement membrane (anti-GBM) disease and proposed a risk stratification according to the need of renal replacement therapy (RRT) and the percentage of normal glomeruli (N). Herein, we analyzed the risk factors associated with kidney outcomes in patients with biopsy-proven anti-GBM disease and evaluated these 2 prognosis systems.

          Methods

          A total of 120 patients with biopsy-proven anti-GBM disease with complete clinicopathologic and outcome data were analyzed.

          Results

          The median time to kidney biopsy was 41 days (interquartile range [IQR]: 22–63 days). RRT and N were the only independent predictors of end-stage kidney disease (ESKD). Patients with N ≥10% were more likely to achieve ESKD-free outcomes, even in the subcohort of patients who underwent posttreatment biopsies ( P < 0.001). N and serum creatinine at presentation (cut-off values 750 μmol/l and 1300 μmol/l) were 2 independent factors for predicting kidney recovery. The RRS and the risk stratification tool exhibited predictive value for ESKD and could be transferred to patients with kidney biopsy following treatment (Harrell’s C statistic [ C] = 0.738 and C = 0.817, respectively). However, a cross-over of outcomes among groups was observed in the risk stratification tool in long-term follow-up, when patients with RRT and N ≥10% achieved better kidney outcomes than those without RRT but N <10%.

          Conclusion

          Normal glomeruli percentage, even posttreatment, was a strong indicator for kidney outcomes, especially on long-term prognosis. Serum creatinine is a predictor for kidney recovery, independent of biopsy findings. The risk stratification tool for kidney survival was transferrable to patients with anti-GBM disease with biopsy following treatment in our cohort; however, this needs further validations for long-term outcomes.

          Graphical abstract

          Related collections

          Most cited references18

          • Record: found
          • Abstract: not found
          • Article: not found
          Is Open Access

          KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases

          Brad H Rovin, Sharon G. Adler, Jonathan Barratt … (2021)
          Article 0 comments Cited 536 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            ANCA-associated vasculitis

            A. Kitching, Hans-Joachim Anders, Neil Basu … (2020)
            The anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) are a group of disorders involving severe, systemic, small-vessel vasculitis and are characterized by the development of autoantibodies to the neutrophil proteins leukocyte proteinase 3 (PR3-ANCA) or myeloperoxidase (MPO-ANCA). The three AAV subgroups, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis and eosinophilic GPA (EGPA), are defined according to clinical features. However, genetic and other clinical findings suggest that these clinical syndromes may be better classified as PR3-positive AAV (PR3-AAV), MPO-positive AAV (MPO-AAV) and, for EGPA, by the presence or absence of ANCA (ANCA+ or ANCA-, respectively). Although any tissue can be involved in AAV, the upper and lower respiratory tract and kidneys are most commonly and severely affected. AAVs have a complex and unique pathogenesis, with evidence for a loss of tolerance to neutrophil proteins, which leads to ANCA-mediated neutrophil activation, recruitment and injury, with effector T cells also involved. Without therapy, prognosis is poor but treatments, typically immunosuppressants, have improved survival, albeit with considerable morbidity from glucocorticoids and other immunosuppressive medications. Current challenges include improving the measures of disease activity and risk of relapse, uncertainty about optimal therapy duration and a need for targeted therapies with fewer adverse effects. Meeting these challenges requires a more detailed knowledge of the fundamental biology of AAV as well as cooperative international research and clinical trials with meaningful input from patients.
            Article 0 comments Cited 235 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              The Oxford classification of IgA nephropathy: pathology definitions, correlations, and reproducibility.

              Ian Roberts, H. Cook, Stéphan Troyanov … (2009)
              Pathological classifications in current use for the assessment of glomerular disease have been typically opinion-based and built on the expert assumptions of renal pathologists about lesions historically thought to be relevant to prognosis. Here we develop a unique approach for the pathological classification of a glomerular disease, IgA nephropathy, in which renal pathologists first undertook extensive iterative work to define pathologic variables with acceptable inter-observer reproducibility. Where groups of such features closely correlated, variables were further selected on the basis of least susceptibility to sampling error and ease of scoring in routine practice. This process identified six pathologic variables that could then be used to interrogate prognostic significance independent of the clinical data in IgA nephropathy (described in the accompanying article). These variables were (1) mesangial cellularity score; percentage of glomeruli showing (2) segmental sclerosis, (3) endocapillary hypercellularity, or (4) cellular/fibrocellular crescents; (5) percentage of interstitial fibrosis/tubular atrophy; and finally (6) arteriosclerosis score. Results for interobserver reproducibility of individual pathological features are likely applicable to other glomerulonephritides, but it is not known if the correlations between variables depend on the specific type of glomerular pathobiology. Variables identified in this study withstood rigorous pathology review and statistical testing and we recommend that they become a necessary part of pathology reports for IgA nephropathy. Our methodology, translating a strong evidence-based dataset into a working format, is a model for developing classifications of other types of renal disease.
              Article 0 comments Cited 177 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Xiao-yu Jia
                Journal
                Journal ID (nlm-ta): Kidney Int Rep
                Journal ID (iso-abbrev): Kidney Int Rep
                Title: Kidney International Reports
                Publisher: Elsevier
                ISSN (Electronic): 2468-0249
                Publication date PMC-release: 18 December 2023
                Publication date Collection: March 2024
                Publication date (Electronic): 18 December 2023
                Volume: 9
                Issue: 3
                Pages: 624-634
                Affiliations
                [1 ]Renal Division, Peking University First Hospital, Beijing, China
                [2 ]Institute of Nephrology, Peking University, Beijing, China
                [3 ]Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
                [4 ]Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
                [5 ]Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
                Author notes
                [∗ ] Correspondence: Xiao-yu Jia, Renal Division of Peking University First Hospital, No.8 Xishiku Street, Xicheng District, Beijing 100034, China. constancej@ 123456163.com
                Article
                Publisher Item ID: S2468-0249(23)01633-9
                DOI: 10.1016/j.ekir.2023.12.011
                PMC ID: 10927471
                SO-VID: 0146358b-e3b9-490b-881c-b4aa3902af48
                Copyright © © 2023 International Society of Nephrology. Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 3 June 2023
                Date revision received : 21 November 2023
                Date accepted : 13 December 2023
                Categories
                Subject: Clinical Research

                Keywords: antiglomerular basement membrane disease,normal glomeruli,prognosis,renal replacement therapy,renal risk score
                Data availability:
                Keywords: antiglomerular basement membrane disease, normal glomeruli, prognosis, renal replacement therapy, renal risk score

                Comments

                Comment on this article