Ellis Carla L, Manno Rebecca L, Havill John P, Racusen Lorraine C, Geetha Duvuru
Medicine, The Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland, USA.
BMC Nephrol. 2013 Oct 4;14:210. doi: 10.1186/1471-2369-14-210.
Renal biopsies provide important diagnostic and prognostic information in ANCA associated glomerulonephritis. A new classification for prognostication of pauci-immune glomerulonephritis (GN) based on four categories (Mixed, Crescentic, Sclerotic and Focal) was proposed by an international working group of renal pathologists (IWGRP). The goal of our study was to apply the proposed classification system to a United States cohort of vasculitis patients and determine the association of IWGRP class with estimated glomerular filtration rate (eGFR) at one year.
Seventy-six cases of pauci-immune glomerulonephritis diagnosed from 1995 to 2011 from a single center were identified for this retrospective study. Clinical data were collected by abstraction from medical records. Histology was reviewed by a pathologist and classified according to the new classification. MDRD formula was used to calculate eGFR. We correlated IWGRP class to renal function at presentation and at one year. ×2, ANOVA, and linear regression analysis were performed as appropriate.
Renal biopsies were categorized as focal: n = 20, crescentic: n = 18, mixed: n = 27, sclerotic: n = 11. The baseline e-GFR was lowest in the crescentic class and highest in the focal class. In linear regression analysis investigating e-GFR at 1 year; age and baseline e-GFR were independent predictors of e-GFR at 1 year.
The e-GFR at diagnosis and age were predictors of e-GFR at 1 year. Pathologic class at diagnosis may also be a helpful tool in risk stratification at diagnosis.
肾活检为抗中性粒细胞胞浆抗体（ANCA）相关性肾小球肾炎提供重要的诊断和预后信息。一个国际肾脏病理学家工作组（IWGRP）提出了一种基于四类（混合性、新月体性、硬化性和局灶性）的寡免疫性肾小球肾炎（GN）预后新分类。我们研究的目的是将所提出的分类系统应用于美国一组血管炎患者，并确定IWGRP分类与一年时估计肾小球滤过率（eGFR）之间的关联。
本回顾性研究纳入了1995年至2011年在单一中心诊断的76例寡免疫性肾小球肾炎病例。通过查阅病历收集临床数据。由一名病理学家复查组织学并根据新分类进行分类。使用简化肾脏病膳食改良试验（MDRD）公式计算eGFR。我们将IWGRP分类与就诊时及一年时的肾功能进行关联分析。视情况进行卡方检验、方差分析和线性回归分析。
肾活检分类为局灶性：n = 20，新月体性：n = 18，混合性：n = 27，硬化性：n = 11。新月体性组的基线e-GFR最低，局灶性组最高。在研究一年时e-GFR的线性回归分析中；年龄和基线e-GFR是一年时e-GFR的独立预测因素。
诊断时的e-GFR和年龄是一年时e-GFR的预测因素。诊断时的病理分类也可能是诊断时风险分层的一个有用工具。
