Commentary: Outcome Predictors of Biopsy-Proven Myeloperoxidase-Anti-Neutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.

Abstract

Diagnosis of Antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) with glomerulonephritis (ANCA-GN) enjoins the start of an immunosuppressive treatment as soon as possible. Its intensity is guided by clinical presentation and histopathologic lesions on kidney biopsy. Individualized and personalized treatment is a key issue for improving outcomes. In this view, markers of AAV severity, renal involvement, and overall prognosis may be useful, not only for a better understanding of the disease pathophysiology, but above all, for guiding therapies and improving patients’ outcomes, especially when histology is not available. Moreover, if chronic lesions in kidney biopsy at diagnosis remain a major determinant of renal outcomes, whether assessed by the international histopathologic classification (1), the Renal Risk Score (2) or the global chronicity score proposed by the Mayo Clinic (3), some intermediate prognostic classes (e.g. crescentic and mixed classes in Berden’s classification) actually seem to have similar renal outcomes (4). Thus, biomarkers are needed to refine the prognosis assessment of these patients. We therefore read we much interest the publication by Ge et al. regarding the role of several biological markers associated with death and end stage kidney disease (ESKD) in MPO-ANCA vasculitis patients with pauci-immune glomerulonephritis (MPO-ANCA-GN), especially anemia and hypoalbuminemia (5). In their cohort of 112 patients, albuminemia < 30 g/L and hemoglobin < 9g/dL were associated with a greater risk of ESKD occurrence. Moreover, hypoalbuminemia (but not anemia) was associated with patient survival.