Yamagata Kunihiro, Usui Joichi, Nagata Michio, Sugiyama Hitoshi, Sada Ken-Ei, Muso Eri, Harigai Masayoshi, Amano Koichi, Atsumi Tatsuya, Fujimoto Shouichi, Yuzawa Yukio, Kobayashi Masaki, Saito Takao, Ito Takafumi, Hirawa Nobuhito, Homma Sakae, Dobashi Hiroaki, Tsuboi Naotaka, Ishizu Akihiro, Arimura Yoshihiro, Makino Hirofumi, Matsuo Seiichi
Department of Nephrology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Department of Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Clin Exp Nephrol. 2019 Mar;23(3):387-394. doi: 10.1007/s10157-018-1656-1. Epub 2018 Oct 10.
The prognostic value of the EUVAS-proposed histopathological classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis has been evaluated throughout the world. Here, we performed a Japanese nationwide biopsy survey to assess the association between this histopathological classification and renal prognosis after 2-year follow-up in ANCA-associated glomerulonephritis.
We collected 67 renal biopsy materials of the 321 entries in the RemIT-JAV-RPGN cohort study, and assessed their histologies. Based on the EUVAS-proposed histopathological classification and some histological parameters, we statistically evaluated renal survival and the comparison of renal function for 2 years.
Based on the histopathological classification, the largest number of biopsy samples belonged to the Focal class, followed by the Mixed, Crescentic, and Sclerotic classes (n = 30, 19, 10, 8, respectively). Although the number of events might be too low (four patients with renal death) to make this conclusion, the Focal and Mixed classes had higher renal-survival rates compared to the others in the renal-survival curve. Comparing renal function among all classes, the estimated glomerular filtration rate (eGFR) throughout 2-year follow-up period was significantly higher in the Focal class compared to the other 3 classes. The eGFR-values in the Crescentic, Mixed, and Sclerotic classes increased with time. Based on both combined results, the Focal class could be the best prognosis.
This histopathological classification was valuable for both the stratification of renal function and the estimation of partial renal survival during 2-year follow-up in ANCA-associated glomerulonephritis.
欧洲血管炎研究组（EUVAS）提出的抗中性粒细胞胞浆抗体（ANCA）相关肾小球肾炎组织病理学分类的预后价值已在全球范围内得到评估。在此，我们进行了一项日本全国性活检调查，以评估这种组织病理学分类与ANCA相关肾小球肾炎2年随访后的肾脏预后之间的关联。
我们从RemIT-JAV-RPGN队列研究的321份记录中收集了67份肾活检材料，并评估了它们的组织学情况。基于EUVAS提出的组织病理学分类和一些组织学参数，我们对肾脏生存率和2年的肾功能情况进行了统计学评估。
基于组织病理学分类，活检样本数量最多的属于局灶性类别，其次是混合性、新月形和硬化性类别（分别为n = 30、19、10、8）。尽管事件数量可能太少（4例肾脏死亡患者），无法得出这一结论，但在肾脏生存曲线中，局灶性和混合性类别与其他类别相比具有更高的肾脏生存率。比较所有类别之间的肾功能，局灶性类别在整个2年随访期内的估计肾小球滤过率（eGFR）显著高于其他3个类别。新月形、混合性和硬化性类别的eGFR值随时间增加。基于这两个综合结果，局灶性类别可能预后最佳。
这种组织病理学分类对于ANCA相关肾小球肾炎2年随访期间的肾功能分层和部分肾脏生存估计均有价值。
