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Validation of the renal risk score for antineutrophil cytoplasmic antibody-associated glomerulonephritis in a Chinese population

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Abstract

Introduction

In 2018, a renal risk score of antineutrophil cytoplasmic antibody (ANCA)–associated glomerulonephritis (AAGN) based on estimated glomerular filtration rate (eGFR), normal glomeruli, and tubular atrophy/interstitial fibrosis (TA/IF) was proposed to predict renal outcomes. We aimed to evaluate this renal risk score in a myeloperoxidase (MPO)–ANCA predominant population in Northeast China.

Methods

We retrospectively analyzed the clinicopathologic data of 65 patients biopsy-proven from a Chinese medical center. Each patient was assessed by eGFR, normal glomeruli, and TA/IF, and the renal outcome was evaluated using the renal risk score.

Results

In our study, 95.4% of patients were ANCA positive (78.5% MPO-ANCA positive and 16.9% proteinase 3-ANCA positive). The average follow-up period was 14.3 months. Thirty-four patients (52.3%) reached end-stage renal disease (ESRD). Based on the renal risk score, 8 (12.3%), 31 (47.7%), and 26 (40%) patients were divided into the low-risk, medium-risk, and high-risk groups, respectively. Kaplan–Meier survival curves revealed the high-risk group had worse renal outcomes than the low-risk group (p<0.01) and the medium-risk group (p<0.01), but the renal outcome did not differ between the low-risk and medium-risk groups (p>0.017). Similar results were obtained by the competitive survival analysis. The AUC for 3-year overall ESRD predictions was 0.845. In the regression analysis, the renal risk score was a favorable predictor for the development of ESRD (HR 3.13, 95%CI 1.58–6.19, p=0.001).

Conclusion

The renal risk score is a preferred index that can predict ESRD in Chinese AAGN patients, especially in the high-risk group with worse renal outcomes.

Key Points

• The eGFR and percentage of normal glomeruli were valuable predictors of renal outcome, whereas TA/IF was not.

• We confirmed the renal risk score is a preferred index that can predict ESRD in Chinese AAGN patients.

• Based on the renal risk score, the high-risk group had worse renal outcomes than the low-risk group and the medium-risk group.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

Code availability

Not applicable.

Abbreviations

ANCA:

Antineutrophil cytoplasmic antibody

AAV:

Anti-neutrophil cytoplasmic antibody-associated vasculitis

AAGN:

Antineutrophil cytoplasmic antibody-associated glomerulonephritis

eGFR:

Estimated glomerular filtration rate

TA/IF:

Tubular atrophy/interstitial fibrosis

MPO:

Myeloperoxidase

PR3:

Proteinase 3

ESRD:

Reached end-stage renal disease

AUC:

Area under curve

IWGRP:

International working group of renal pathologists

CHCC:

Chapel Hill consensus criteria

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Funding

This study was funded in part by grants from the National Natural Science Foundation of China (81970628), Science and Technology Development Plan Project of Jilin province (20200201488JC, 20190304042YY), and the Jilin Province Sanitation and Health Technology Innovation Project (2018J048).

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Authors and Affiliations

  1. Department of Nephrology, The Second Hospital of Jilin University, Changchun, 130041, China

    Xue Bai, Qiaoyan Guo, Yan Lou, Ping Nie, Yuexin Zhu, Bing Li & Ping Luo

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  1. Xue Bai
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  2. Qiaoyan Guo
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  3. Yan Lou
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  4. Ping Nie
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  5. Yuexin Zhu
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  6. Bing Li
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Contributions

Xue Bai: investigation, software, data analysis, writing—original draft.

Qiaoyan Guo: revision.

Yan Lou: resources, investigation.

Ping Nie: resources, investigation.

Yuexin Zhu: data analysis.

Bing Li: pathological diagnosis, supervision, funding acquisition.

Ping Luo: pathological diagnosis, supervision, funding acquisition, resources.

Corresponding authors

Correspondence to Bing Li or Ping Luo.

Ethics declarations

Statement of ethics

The protocol was approved by the Ethics Committee of The Second Hospital of Jilin University (No. 2020-100), and the research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.

Disclosures

None.

Consent to participate

Informed consent was obtained from all the participants.

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Written informed consent for publication was obtained from all the participants.

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Supplementary information

Supplementary Fig. S1

Organ system involvement beyond the kidney in different ANCA subtypes (TIF 950 kb)

High resolution image (PNG 423 kb)

Supplementary Fig. S2

Comparison of cumulative incidence of ESRD or Death of different renal risk score group. ESRD, low-risk: low-risk group progress to ESRD; ESRD, medium-risk: medium-risk group progress to ESRD; ESRD, high-risk: high-risk group progress to ESRD; Death, low-risk: low-risk group progress to death; Death, medium-risk: medium-risk group progress to death; Death, high-risk: high-risk group progress to death. CIF: cumulative incidence function. (TIF 5541 kb)

High resolution image (PNG 202 kb)

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Bai, X., Guo, Q., Lou, Y. et al. Validation of the renal risk score for antineutrophil cytoplasmic antibody-associated glomerulonephritis in a Chinese population. Clin Rheumatol 40, 5009–5017 (2021). https://doi.org/10.1007/s10067-021-05862-w

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