ANCA renal risk score predicts outcome in the Manchester cohort

Abstract

Antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides are multisystem autoimmune disorders that cause irreversible damage to affected organs. In past decades, patient and renal survival have improved. Disease control is achieved in most patients, and the most common cause of first-year mortality is infection. 1 Flossmann O. Berden A. de Groot K. et al. Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis. 2011; 70: 488-494 Crossref PubMed Scopus (573) Google Scholar Therefore, the right balance is needed to gain rapid control of vasculitis without exposing patients to undue risk of aggressive immunosuppression. Recently we developed and validated a new clinico-pathologic score to improve outcome prediction. One of our aims was to identify a sub cohort of patients unlikely to regain kidney function that potentially could be spared full induction treatment for renal survival purposes. 2 Brix S.R. Noriega M. Tennstedt P. et al. Development and validation of a renal risk score in ANCA-associated glomerulonephritis. Kidney Int. 2018; 94: 1177-1188 Abstract Full Text Full Text PDF Scopus (108) Google Scholar To further validate the ANCA renal risk score, we retrospectively investigated another independent patient cohort of 105 patients with ANCA-associated glomerulonephritis from Manchester, UK. Development and validation of a renal risk score in ANCA-associated glomerulonephritisKidney InternationalVol. 94Issue 6PreviewPredicting renal outcome in antineutrophil cytoplasmic antibody (ANCA)–associated glomerulonephritis (GN) remains a major challenge. We aimed to identify reliable predictors of end-stage renal disease (ESRD) and to develop and validate a clinicopathologic score to predict renal outcome in ANCA-associated GN. In a prospective training cohort of 115 patients, the percentage of normal glomeruli (without scarring, crescents, or necrosis within the tuft) was the strongest independent predictor of death-censored ESRD. Full-Text PDF Open ArchiveThe authors replyKidney InternationalVol. 99Issue 2PreviewWe would like to thank Tan et al.1 for validating and confirming our antineutrophil cytoplasm antibody (ANCA) renal risk score.2 In a retrospective, single-center London cohort of 178 patients, the score determined renal survival dependent on patients’ risk groups at the 36-month follow-up (P < 0.001; 95%, 90%, and 45%, respectively). Full-Text PDF