新月体性肾小球肾炎中预测肾脏结局的新组织病理学指标。
Novel histopathologic predictors for renal outcomes in crescentic glomerulonephritis.
机构信息
Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
出版信息
PLoS One. 2020 Jul 27;15(7):e0236051. doi: 10.1371/journal.pone.0236051. eCollection 2020.
INTRODUCTION
Crescentic glomerulonephritis (CrGN) is a histologic feature of severe glomerular injury, clinically characterized by a rapid decline of renal function when not treated in a timely fashion. Factors associated with CrGN prognosis have not been thoroughly investigated. This study investigated the prognostic predictors of renal outcomes associated with CrGN, such as the histopathologic classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis, arteriosclerosis, and tertiary lymphoid organ (TLO) formation.
METHODS
A total of 114 patients diagnosed with CrGN between 2010 and 2018 at two university-based hospitals has been retrospectively analyzed. Relationships between potential predictors and renal outcomes were analyzed using Cox proportional hazards model and linear regression analysis.
RESULTS
The mean age was 61.0 ± 15.3 years, and 49.1% were male. Among them, 92 (80.7%) and 11 (9.6%) patients were positive for ANCA and for anti-glomerular basement membrane antibody, respectively. During the median follow-up of 458.0 days, 55 patients (48.2%) had advanced to end-stage renal disease (ESRD). Cox proportional hazards analysis revealed that patients under the mixed and sclerotic classes had worse renal survival compared to those in the focal class (mixed: hazard ratio [HR], 3.74; 95% confidence interval [CI], 1.18 to 11.82; P = 0.025; sclerotic: HR, 4.84; 95% CI, 1.44 to 16.32; P = 0.011). Severe arteriosclerosis was also associated with poor renal survival (HR, 2.44; 95% CI, 1.04 to 5.77; P = 0.042). TLOs were observed in 41 patients (36.0%). Moreover, TLO formation was also a prognostic factor for ESRD (HR, 1.82; 95% CI, 1.03 to 3.21; P = 0.040). In the multivariate linear regression analysis, age and sclerotic class were independent predictors for the change in estimated glomerular filtration rate during 1 year after biopsy.
CONCLUSIONS
Specific histopathologic findings, histopathologic classification, severity of arteriosclerosis, and TLO formation provide helpful information in predicting renal outcomes associated with CrGN.
简介
新月体性肾小球肾炎（CrGN）是严重肾小球损伤的组织学特征，临床上表现为肾功能迅速下降，如果不及时治疗。与 CrGN 预后相关的因素尚未得到彻底研究。本研究调查了与 CrGN 相关的肾脏预后的预测因素，如抗中性粒细胞胞浆抗体（ANCA）相关性肾小球肾炎、动脉硬化和三级淋巴器官（TLO）形成的组织病理学分类。
方法
回顾性分析了 2010 年至 2018 年间在两所大学医院诊断为 CrGN 的 114 例患者。使用 Cox 比例风险模型和线性回归分析分析了潜在预测因子与肾脏结局之间的关系。
结果
平均年龄为 61.0±15.3 岁，男性占 49.1%。其中，92 例（80.7%）和 11 例（9.6%）患者的抗中性粒细胞胞浆抗体和抗肾小球基底膜抗体呈阳性。在中位随访 458.0 天期间，55 例（48.2%）患者进展至终末期肾病（ESRD）。Cox 比例风险分析显示，与局灶性病变患者相比，混合性和硬化性病变患者的肾脏生存率更差（混合性：风险比[HR]，3.74；95%置信区间[CI]，1.18 至 11.82；P=0.025；硬化性：HR，4.84；95%CI，1.44 至 16.32；P=0.011）。严重的动脉硬化也与不良的肾脏生存率相关（HR，2.44；95%CI，1.04 至 5.77；P=0.042）。41 例患者（36.0%）观察到 TLO 形成。此外，TLO 形成也是 ESRD 的预后因素（HR，1.82；95%CI，1.03 至 3.21；P=0.040）。在多元线性回归分析中，年龄和硬化性病变是活检后 1 年内估计肾小球滤过率变化的独立预测因子。
结论
特定的组织病理学发现、组织病理学分类、动脉硬化的严重程度和 TLO 的形成提供了与 CrGN 相关的肾脏预后的有价值的信息。
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