Research ANCA-associated Glomerulonephritis Pathological Type And Its Clinical Significance

BackgroundAnti-neutrophil cytoplasmic antibodies (ANCA) associated vasculitis insults kidney very common, and sometimes leads to renal function severely injuried. Some study groups have been aiming at correlation between pathologic factors and prognosis, and several important items have been found. But there was no any Histopathological classification system for the disease until Berden and his colleagues gave their proposal. However, no validation study has been published yet. We think it’s important to do the validation work and find out whether the Berden classification can assist in prognosis and treatment.ObjectiveTo evaluate the correlation between pathologic factors and prognosis; to assess the value of Berden classification in making prognosis and treatment.Methods(1) We collected pathological and clinical information of49patients for whom a diagnosis of ANCA associated vasculitis had been confirmed and had confirmed renal involvement by renal biopsy. We made the correlation analysis between pathologic factors renal function.(2) We classified all the patient with the procedure provided by Berden, then compared the difference among each groups in renal function, dialysis dependent rate, death rate, also response for treatment and side effect rate.Results(1) The percentage of normal glomeruli, globally sclerotic glomeruli, fibrousis crescent, interstitium fibrosis and tubular atropy are correlated with short-or long-term renal outcome. The percentage of cellular crescent is related to the baseline renal function and its recovery degree. The percentage of VCAM-1positive glomeruli and the amount of CD68positive macrophage are both negatively only correlated with baseline renal function.(2) Based on our own records, focal class has relatively preserved renal function and favourable renal outcome. While the sclerotic class has the worst renal outcome. Crescentic class and mixed class have an intermediate outcome, and the best recovery ability.(3) Infection rate is similar among classes, but methylprednisolone impulse group has more hospital acquired pulmonary infection than the group without pulse (43%VS5%). As for death event,11of13events are related to infection.Conclusion(1) The percentage of normal glomeruli is the best pathological predictors of short-or long-term renal outcome.。(2) Berden classification can direct prognosis assessment. And patients of different classes need different therapy strategy。...