Document Detail


Prediction of ESRD in pauci-immune necrotizing glomerulonephritis: quantitative histomorphometric assessment and serum creatinine.
MedLine Citation:
PMID:  20045237     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Clinical and pathologic features that predict outcome have important potential application in patients with pauci-immune necrotizing glomerulonephritis (usually antineutrophil cytoplasmic antibody-associated vasculitis). This study examines the predictive value of simple quantitative renal histologic measurements in a large cohort with extended follow-up.
STUDY DESIGN: Cohort study.
SETTING & PARTICIPANTS: 390 consecutive patients with pauci-immune necrotizing glomerulonephritis at a single hospital (1983-2002); 90 patients underwent repeated kidney biopsy during follow-up.
PREDICTORS: Age and serum creatinine concentration at biopsy, antineutrophil cytoplasmic antibody specificity, percentage of normal glomeruli, percentage of glomeruli with active lesions, and index of chronic damage (quantitative measurement of established cortical damage) in the initial kidney biopsy for all patients. The same factors were assessed in both biopsy specimens for patients undergoing an additional biopsy.
OUTCOMES & MEASUREMENTS: End-stage renal disease and patient survival.
RESULTS: Mortality at 1 and 5 years was 23% and 40%, respectively: standardized mortality ratio, 4.74 (95% CI, 3.62-6.32). End-stage renal disease was reached by 14% and 18% at 1 and 5 years, respectively. In multivariable analysis, serum creatinine level at biopsy and percentage of normal glomeruli in the initial biopsy specimen were the best predictors of kidney survival. C Statistics were 0.80 for creatinine level alone and 0.83 for creatinine level with normal glomeruli. In patients undergoing an additional biopsy, rapid progression in the index of chronic damage and serum creatinine level at the second biopsy were associated with kidney survival in multivariable analysis.
LIMITATIONS: Retrospective analysis. External validity of the index of chronic damage requires further assessment. Selection bias may influence repeated biopsy analyses.
CONCLUSIONS: Serum creatinine level at biopsy best predicts kidney survival in patients with pauci-immune necrotizing glomerulonephritis overall.
Authors:
Clara J Day; Alec J Howie; Peter Nightingale; Shazia Shabir; Dwomoa Adu; Caroline O Savage; Peter Hewins
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-12-31
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  55     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-02-22     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  250-8     Citation Subset:  IM    
Copyright Information:
Crown Copyright 2010. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Nephrology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / blood*,  pathology*
Cohort Studies
Creatinine / blood*
Follow-Up Studies
Glomerulonephritis / blood*,  complications,  pathology*
Humans
Kidney Failure, Chronic / blood*,  etiology,  pathology*
Middle Aged
Necrosis
Predictive Value of Tests
Retrospective Studies
Young Adult
Grant Support
ID/Acronym/Agency:
//Medical Research Council; //Wellcome Trust
Chemical
Reg. No./Substance:
60-27-5/Creatinine
Comments/Corrections

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