Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis

Yong-Xi Chen^{1

2}, Jing Xu^{1

2}, Xiao-Xia Pan^{1

2}, Ping-Yan Shen^{1

2}, Xiao Li^{1

2}, Hong Ren^{1

2}, Xiao-Nong Chen^{1

2}, Li-Yan Ni^{1

2}, Wen Zhang^{3

4}, Nan Chen^{1

2}

Affiliations

¹ From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
² Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
³ From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China. zhangwen255@163.com chen-nan@medmail.com.cn.
⁴ Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine. zhangwen255@163.com chen-nan@medmail.com.cn.

PMID: 27980013
DOI: 10.3899/jrheum.160866

Meta-Analysis

Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis

Yong-Xi Chen et al. J Rheumatol. 2017 Mar.

. 2017 Mar;44(3):304-313.

doi: 10.3899/jrheum.160866. Epub 2016 Dec 15.

Authors

Yong-Xi Chen^{1

2}, Jing Xu^{1

2}, Xiao-Xia Pan^{1

2}, Ping-Yan Shen^{1

2}, Xiao Li^{1

2}, Hong Ren^{1

2}, Xiao-Nong Chen^{1

2}, Li-Yan Ni^{1

2}, Wen Zhang^{3

4}, Nan Chen^{1

2}

Affiliations

¹ From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China.
² Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine.
³ From the Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China. zhangwen255@163.com chen-nan@medmail.com.cn.
⁴ Y.X. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; J. Xu, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.X. Pan, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; P.Y. Shen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X. Li, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; H. Ren, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; X.N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; L.Y. Ni, BSc, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; W. Zhang, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine; N. Chen, MD, Department of Nephrology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine. zhangwen255@163.com chen-nan@medmail.com.cn.

PMID: 27980013
DOI: 10.3899/jrheum.160866

Abstract

Objective: Renal vasculitis is one of the most common manifestations of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) and renal histology is a key predictor of the outcome. A new histopathologic classification was proposed and validated, but the results are still debated.

Methods: We performed a retrospective analysis to validate the histopathologic classification and performed a metaanalysis to evaluate its predictive value. There were 186 patients with ANCA-associated renal vasculitis diagnosed at Ruijin Hospital who were enrolled in the retrospective study. The metaanalysis considered the data for 1601 patients.

Results: In our retrospective study, patients with focal class had the best renal outcome while patients with mixed class had the worst (p < 0.001). Metaanalysis showed that patients with focal class had better renal outcome than did those with crescentic class [risk ratio (RR) 0.23, 95% CI 0.16-0.34, p < 0.00001], with no evidence of heterogeneity (I² = 0%, p = 0.96). Patients with crescentic class had better renal outcome than did those with sclerotic class (RR 0.52, 95% CI 0.41-0.64, p < 0.00001), with no evidence of heterogeneity (I² = 2%, p = 0.43). We did not find statistical significance regarding renal outcome between mixed and crescentic classes (RR 1.14, 95% CI 0.91-1.43, p = 0.27), with no evidence of heterogeneity (I² = 23%, p = 0.19). The retrospective study showed that lung and upper respiratory tract involvement were the most common extrarenal manifestations.

Conclusion: We demonstrated the clinical utility of histopathologic classification in determining renal outcome in patients with AAV. Metaanalysis showed that patients with focal class had the best outcome while sclerotic class had the worst.

Keywords: ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES; HISTOPATHOLOGIC CLASSIFICATION; METAANALYSIS; OUTCOME; RENAL VASCULITIS.

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The Histopathological Classification of ANCA-associated Glomerulonephritis Comes of Age.
Tanna A, Pusey CD. Tanna A, et al. J Rheumatol. 2017 Mar;44(3):265-267. doi: 10.3899/jrheum.170006. J Rheumatol. 2017. PMID: 28250161 No abstract available.

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Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis

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Histopathological Classification and Renal Outcome in Patients with Antineutrophil Cytoplasmic Antibodies-associated Renal Vasculitis: A Study of 186 Patients and Metaanalysis

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