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Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis
BACKGROUND: Antineutrophil-cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determin...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689158/ https://www.ncbi.nlm.nih.gov/pubmed/38046032 http://dx.doi.org/10.1093/ckj/sfad157 |
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author | Boud'hors, Charlotte Riou, Jérémie Fage, Nicolas Samoreau, Clément Desouche, Alice Gatault, Philippe Bridoux, Frank Martin, Cécile Wacrenier, Samuel Vinatier, Emeline Djema, Assia Henry, Nicolas Croué, Anne Piccoli, Giorgina Barbara Copin, Marie-Christine Augusto, Jean-François Brilland, Benoît |
author_facet | Boud'hors, Charlotte Riou, Jérémie Fage, Nicolas Samoreau, Clément Desouche, Alice Gatault, Philippe Bridoux, Frank Martin, Cécile Wacrenier, Samuel Vinatier, Emeline Djema, Assia Henry, Nicolas Croué, Anne Piccoli, Giorgina Barbara Copin, Marie-Christine Augusto, Jean-François Brilland, Benoît |
author_sort | Boud'hors, Charlotte |
collection | PubMed |
description | BACKGROUND: Antineutrophil-cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determine whether kidney function and markers of AAV-GN activity after 6 months could improve the prediction of ESKD. METHODS: This retrospective and observational study included adult patients with AAV-GN recruited from six French nephrology centers (including from the Maine-Anjou AAV registry). The primary outcome was kidney survival. Analyses were conducted in the whole population and in a sub-population that did not develop ESKD early in the course of the disease. RESULTS: When considering the 102 patients with all data available at diagnosis, Berden classification and Renal Risk Score (RRS) were not found to be better than kidney function [estimated glomerular filtration rate (eGFR)] alone at predicting ESKD (C-index = 0.70, 0.79, 0.82, respectively). Multivariables models did not indicate an improved prognostic value when compared with eGFR alone. When considering the 93 patients with all data available at 6 months, eGFR outperformed Berden classification and RRS (C-index = 0.88, 0.62, 0.69, respectively) to predict ESKD. RRS performed better when it was updated with the eGFR at 6 months instead of the baseline eGFR. While 6-month proteinuria was associated with ESKD and improved ESKD prediction, hematuria and serological remission did not. CONCLUSION: This work suggests the benefit of the reassessment of the kidney prognosis 6 months after AAV-GN diagnosis. Kidney function at this time remains the most reliable for predicting kidney outcome. Of the markers tested, persistent proteinuria at 6 months was the only one to slightly improve the prediction of ESKD. |
format | Online Article Text |
id | pubmed-10689158 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-106891582023-12-02 Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis Boud'hors, Charlotte Riou, Jérémie Fage, Nicolas Samoreau, Clément Desouche, Alice Gatault, Philippe Bridoux, Frank Martin, Cécile Wacrenier, Samuel Vinatier, Emeline Djema, Assia Henry, Nicolas Croué, Anne Piccoli, Giorgina Barbara Copin, Marie-Christine Augusto, Jean-François Brilland, Benoît Clin Kidney J Original Article BACKGROUND: Antineutrophil-cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with kidney involvement (AAV-GN) frequently evolves to end-stage kidney disease (ESKD) despite aggressive immunosuppressive treatment. Several risk scores have been used to assess renal prognosis. We aimed to determine whether kidney function and markers of AAV-GN activity after 6 months could improve the prediction of ESKD. METHODS: This retrospective and observational study included adult patients with AAV-GN recruited from six French nephrology centers (including from the Maine-Anjou AAV registry). The primary outcome was kidney survival. Analyses were conducted in the whole population and in a sub-population that did not develop ESKD early in the course of the disease. RESULTS: When considering the 102 patients with all data available at diagnosis, Berden classification and Renal Risk Score (RRS) were not found to be better than kidney function [estimated glomerular filtration rate (eGFR)] alone at predicting ESKD (C-index = 0.70, 0.79, 0.82, respectively). Multivariables models did not indicate an improved prognostic value when compared with eGFR alone. When considering the 93 patients with all data available at 6 months, eGFR outperformed Berden classification and RRS (C-index = 0.88, 0.62, 0.69, respectively) to predict ESKD. RRS performed better when it was updated with the eGFR at 6 months instead of the baseline eGFR. While 6-month proteinuria was associated with ESKD and improved ESKD prediction, hematuria and serological remission did not. CONCLUSION: This work suggests the benefit of the reassessment of the kidney prognosis 6 months after AAV-GN diagnosis. Kidney function at this time remains the most reliable for predicting kidney outcome. Of the markers tested, persistent proteinuria at 6 months was the only one to slightly improve the prediction of ESKD. Oxford University Press 2023-07-04 /pmc/articles/PMC10689158/ /pubmed/38046032 http://dx.doi.org/10.1093/ckj/sfad157 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | Original Article Boud'hors, Charlotte Riou, Jérémie Fage, Nicolas Samoreau, Clément Desouche, Alice Gatault, Philippe Bridoux, Frank Martin, Cécile Wacrenier, Samuel Vinatier, Emeline Djema, Assia Henry, Nicolas Croué, Anne Piccoli, Giorgina Barbara Copin, Marie-Christine Augusto, Jean-François Brilland, Benoît Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title | Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title_full | Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title_fullStr | Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title_full_unstemmed | Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title_short | Adding 6-month parameters for the prediction of kidney prognosis in ANCA-associated glomerulonephritis |
title_sort | adding 6-month parameters for the prediction of kidney prognosis in anca-associated glomerulonephritis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689158/ https://www.ncbi.nlm.nih.gov/pubmed/38046032 http://dx.doi.org/10.1093/ckj/sfad157 |
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