Kuang Huang, Zhao Yi-Yang, Wang Jin-Wei, Cui Zhao, Zhao Ming-Hui, Jia Xiao-Yu
Renal Division, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Kidney Int Rep. 2023 Dec 18;9(3):624-634. doi: 10.1016/j.ekir.2023.12.011. eCollection 2024 Mar.
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.
A total of 120 patients with biopsy-proven anti-GBM disease with complete clinicopathologic and outcome data were analyzed.
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 ( < 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 statistic [] = 0.738 and = 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%.
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.
先前的一项研究表明，肾脏风险评分（RRS）可应用于抗肾小球基底膜（anti-GBM）疾病，并根据肾脏替代治疗（RRT）的需求和正常肾小球（N）的百分比提出了风险分层。在此，我们分析了经活检证实的anti-GBM疾病患者肾脏预后的相关危险因素，并评估了这两种预后系统。
共分析了120例经活检证实的anti-GBM疾病患者，这些患者具有完整的临床病理和预后数据。
肾脏活检的中位时间为41天（四分位间距[IQR]：22 - 63天）。RRT和N是终末期肾病（ESKD）的唯一独立预测因素。N≥10%的患者更有可能实现无ESKD结局，即使在接受治疗后活检的亚组患者中也是如此（<0.001）。N和就诊时的血清肌酐（临界值分别为750 μmol/l和1300 μmol/l）是预测肾脏恢复的两个独立因素。RRS和风险分层工具对ESKD具有预测价值，并且可以应用于治疗后进行肾脏活检的患者（Harrell's统计量[]分别为0.738和0.817）。然而，在长期随访中，风险分层工具中各亚组间出现了结局交叉，即接受RRT且N≥10%的患者肾脏预后优于未接受RRT但N<10%的患者。
正常肾小球百分比，即使是治疗后，也是肾脏预后的有力指标，尤其是对长期预后而言。血清肌酐是肾脏恢复的预测指标，独立于活检结果。在我们的队列中，肾脏生存风险分层工具可应用于治疗后接受活检的anti-GBM疾病患者；然而，这需要对长期结局进行进一步验证。
