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Histopathological classification of anti-neutrophil cytoplasmic antibody-associated glomerulonephritis in a nationwide Japanese prospective 2-year follow-up cohort study

  • Kunihiro Yamagata
  • Joichi Usui
  • Michio Nagata
  • Hitoshi Sugiyama
  • Ken-ei Sada
  • Eri Muso
  • Masayoshi Harigai
  • Koichi Amano
  • Tatsuya Atsumi
  • Shouichi Fujimoto
  • Yukio Yuzawa
  • Masaki Kobayashi
  • Takao Saito
  • Takafumi Ito
  • Nobuhito Hirawa
  • Sakae Homma
  • Hiroaki Dobashi
  • Naotaka Tsuboi
  • Akihiro Ishizu
  • Yoshihiro Arimura
  • Hirofumi Makino
  • Seiichi Matsuo
  • For the Research Committee of Intractable Renal Disease and the Research Committee of Intractable Vasculitis Syndrome of the Ministry of Health, Labour, and Welfare of Japan
Original article
  • 19 Downloads

Abstract

Background

The prognostic value of the EUVAS-proposed histopathological classification of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis has been evaluated throughout the world. Here, we performed a Japanese nationwide biopsy survey to assess the association between this histopathological classification and renal prognosis after 2-year follow-up in ANCA-associated glomerulonephritis.

Methods

We collected 67 renal biopsy materials of the 321 entries in the RemIT-JAV-RPGN cohort study, and assessed their histologies. Based on the EUVAS-proposed histopathological classification and some histological parameters, we statistically evaluated renal survival and the comparison of renal function for 2 years.

Results

Based on the histopathological classification, the largest number of biopsy samples belonged to the Focal class, followed by the Mixed, Crescentic, and Sclerotic classes (n = 30, 19, 10, 8, respectively). Although the number of events might be too low (four patients with renal death) to make this conclusion, the Focal and Mixed classes had higher renal-survival rates compared to the others in the renal-survival curve. Comparing renal function among all classes, the estimated glomerular filtration rate (eGFR) throughout 2-year follow-up period was significantly higher in the Focal class compared to the other 3 classes. The eGFR-values in the Crescentic, Mixed, and Sclerotic classes increased with time. Based on both combined results, the Focal class could be the best prognosis.

Conclusion

This histopathological classification was valuable for both the stratification of renal function and the estimation of partial renal survival during 2-year follow-up in ANCA-associated glomerulonephritis.

Keywords

Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis Histopathological classification Renal prognosis Nationwide prospective cohort study Rapidly progressive glomerulonephritis 

Notes

Acknowledgements

This work was supported by grants from the Research Committee of Intractable Renal Disease and Research Committee of Intractable Vasculitis Syndrome of the Ministry of Health, Labour, and Welfare of Japan.

Research Committee of Intractable Renal Disease and Research Committee of Intractable Vasculitis Syndrome of the Ministry of Health, Labour, and Welfare of Japan: In addition to the authors, the following investigators and institutions participated in this study: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine (Yoshinari Takasaki); Division of Rheumatology and Nephrology, Department of Internal Medicine, Aichi Medical School of Medicine (Shogo Banno); Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology (Takahiko Sugihara); Department of Rheumatology, Shimane University Faculty of Medicine (Yohko Murakawa); Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine (Hitoshi Hasegawa); Department of Hematology, Oncology, Nephrology, and Rheumatology, Akita University School of Medicine (Atsushi Komatsuda); Niigata Rheumatic Center (Satoshi Ito); Department of the Control for Rheumatic Diseases, Graduate School of Medicine, Kyoto University (Takao Fujii); Department of Immunology and Rheumatology, Clinical Neuroscience and Neurology, Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences (Atsushi Kawakami); Department of Nephrology, Iwate Prefectural Central Hospital (Izaya Nakaya); Center for Rheumatology, Okayama Saiseikai General Hospital (Masahiro Yamamura); Department of Medical Technology, School of Health Sciences, Faculty of Medicine, Niigata University (Masaaki Nakano); Department of Medicine, Kidney Center, Tokyo Women’s Medical University (Kosaku Nitta); Division of Nephrology and Hypertension, Kashiwa Hospital, Jikei University (Makoto Ogura); Department of Nephrology, Nagoya City University Graduate School of Medical Sciences (Taio Naniwa); Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine (Shoichi Ozaki); Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo (Junichi Hirahashi); Third Department of Internal Medicine, Division of Immunology and Rheumatology, Hamamatsu University School of Medicine, Hamamatsu (Noriyoshi Ogawa); Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine (Tatsuo Hosoya); Division of Nephrology, Department of Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Medicine, Kanazawa University (Takashi Wada); Division of Nephrology, Department of Internal Medicine, Juntendo University Faculty of Medicine (Satoshi Horikoshi); Institute of Rheumatology, Tokyo Women’s Medical University (Yasushi Kawaguchi); Division of Clinical Immunology, Graduate School of Comprehensive Human Sciences, University of Tsukuba (Taichi Hayashi); Department of Nephrology, Tokyo Medical University Hachioji Medical Center (Masaharu Yoshida); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolic, Fukushima Medical University (Tsuyoshi Watanabe); Department of Nephrology, Japanese Red Cross Nagoya Daini Hospital (Daijo Inaguma); Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University (Kazuhiko Tsuruya); Niigata Prefectural Shibata Hospital (Noriyuki Homma); Department of Pathology, Keio University School of Medicine, Tokyo, Japan (Yasunori Okada); Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine (Tsutomu Takeuchi); Cardiovascular Respiratory and Neurology Division, Department of Internal Medicine, Asahikawa Medical University (Naoki Nakagawa); Kurobe City Hospital (Shinichi Takeda); Fukuoka Higashi Medical Center (Ritsuko Katabuchi); Division of Nephrology, Department of Medicine, Faculty of Medical Sciences, University of Fukui (Masayuki Iwano).

Supplementary material

10157_2018_1656_MOESM1_ESM.xls (34 kb)
Supplemental Table 1. Information of 5 deceased patients. (XLS 33 KB)
10157_2018_1656_MOESM2_ESM.xls (30 kb)
Supplemental Table 2. Clinical findings of the Focal class with or without rapidly progressive glomerulonephritis. Abbreviations: MPA, microscopic polyangiitis; GPA, granulomatous polyangiitis; UC, unclassifiable; ANCA, anti-neutrophil cytoplasmic antibodies; MPO, myeloperoxidase; PR3, proteinase-3; BVAS, Birmingham vasculitis activity score; eGFR, estimated glomerular filtration rate (XLS 30 KB)
10157_2018_1656_MOESM3_ESM.ppt (135 kb)
Supplemental Figure 1. Comparison of eGFR trends between 2 subgroups of the Focal class: patients with and those without rapidly progressive glomerulonephritis. Abbreviations: eGFR, estimated glomerular filtration rate; RPGN, rapidly progressive glomerulonephritis (PPT 135 KB)

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Copyright information

© Japanese Society of Nephrology 2018

Authors and Affiliations

  • Kunihiro Yamagata
    • 1
  • Joichi Usui
    • 1
  • Michio Nagata
    • 2
  • Hitoshi Sugiyama
    • 3
  • Ken-ei Sada
    • 4
  • Eri Muso
    • 5
  • Masayoshi Harigai
    • 6
  • Koichi Amano
    • 7
  • Tatsuya Atsumi
    • 8
  • Shouichi Fujimoto
    • 9
  • Yukio Yuzawa
    • 10
  • Masaki Kobayashi
    • 11
  • Takao Saito
    • 12
  • Takafumi Ito
    • 13
  • Nobuhito Hirawa
    • 14
  • Sakae Homma
    • 15
  • Hiroaki Dobashi
    • 16
  • Naotaka Tsuboi
    • 17
  • Akihiro Ishizu
    • 18
  • Yoshihiro Arimura
    • 19
    • 21
  • Hirofumi Makino
    • 20
  • Seiichi Matsuo
    • 17
  • For the Research Committee of Intractable Renal Disease and the Research Committee of Intractable Vasculitis Syndrome of the Ministry of Health, Labour, and Welfare of Japan
  1. 1.Department of Nephrology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  2. 2.Department of Pathology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
  3. 3.Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
  4. 4.Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Dentistry and Pharmaceutical SciencesOkayama University Graduate School of MedicineOkayamaJapan
  5. 5.Center for Nephrology and Urology, Division of Nephrology and DialysisKitano Hospital, Tazuke Kofukai Medical Research InstituteOsakaJapan
  6. 6.Department of Pharmacovigilance, Department of Medicine and Rheumatology, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
  7. 7.Department of Rheumatology and Clinical Immunology, Saitama Medical CenterSaitama Medical UniversityKawagoeJapan
  8. 8.Division of Rheumatology, Endocrinology and Nephrology at the Graduate School of MedicineHokkaido UniversitySapporoJapan
  9. 9.Department of Internal Medicine, Circulatory and Body Fluid Regulation, Faculty of MedicineUniversity of MiyazakiMiyazakiJapan
  10. 10.Department of NephrologyFujita Health University School of MedicineToyoakeJapan
  11. 11.Department of NephrologyTokyo Medical University Ibaraki Medical CenterAmiJapan
  12. 12.Division of Nephrology and Rheumatology, Department of Internal MedicineFukuoka University School of MedicineFukuokaJapan
  13. 13.Division of Nephrology, Faculty of MedicineShimane UniversityIzumoJapan
  14. 14.Department of Hemodialysis and ApheresisYokohama City University Medical CenterYokohamaJapan
  15. 15.Department of Respiratory MedicineToho University Omori Medical CenterTokyoJapan
  16. 16.Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of MedicineKagawa UniversityKagawaJapan
  17. 17.Department of Nephrology, Internal MedicineNagoya University Graduate School of MedicineAichiJapan
  18. 18.Faculty of Health SciencesHokkaido UniversitySapporoJapan
  19. 19.Nephrology and Rheumatology, First Department of Internal MedicineKyorin University School of MedicineTokyoJapan
  20. 20.Okayama UniversityOkayamaJapan
  21. 21.Kichijoji Asahi HospitalTokyoJapan

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