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Brilland B, Boud'hors C, Copin MC, Jourdain P, Henry N, Wacrenier S, Djema A, Samoreau C, Coindre JP, Cousin M, Riou J, Croue A, Saint-André JP, Subra JF, Piccoli GB, Augusto JF. Assessment of Renal Risk Score and Histopathological Classification for Prediction of End-Stage Kidney Disease and Factors Associated With Change in eGFR After ANCA-Glomerulonephritis Diagnosis. Front Immunol 2022; 13:834878. [PMID: 35392077 PMCID: PMC8981524 DOI: 10.3389/fimmu.2022.834878] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction The “Renal Risk Score” (RRS) and the histopathological classification have been proposed to predict the risk of end-stage kidney disease (ESKD) in ANCA-associated glomerulonephritis (ANCA-GN). Besides, factors associated with kidney function recovery after ANCA-GN onset remain to be more extensively studied. In the present study, we analyzed the value of the RRS and of the histopathological classification for ESKD prediction. Next, we analyzed factors associated with eGFR change within the first 2 years following ANCA-GN diagnosis. Materials and Methods We included patients from the Maine–Anjou ANCA-associated vasculitis registry with at least 6 months of follow-up. The values of ANCA-GN, histopathological classification, and RRS, and the factors associated with eGFR variations between ANCA-GN diagnosis and 2 years of follow-up were assessed. Results The predictive values of the histopathological classification and RRS were analyzed in 123 patients. After a median follow-up of 42 months, 33.3% patients developed ESKD. The predictive value of RRS for ESKD was greater than that of the histopathological classification. Determinants of eGFR variation were assessed in 80/123 patients with complete eGFR measurement. The median eGFR increased from ANCA-GN diagnosis to month 6 and stabilized thereafter. The only factor associated with eGFR variation in our study was eGFR at ANCA-GN diagnosis, with higher eGFR at diagnosis being associated with eGFR loss (p<0.001). Conclusion The RRS has a better predictive value for ESKD than the histopathological classification. The main determinant of eGFR variation at 2 years was eGFR at ANCA-GN diagnosis. Thus, this study suggests that eGFR recovery is poorly predicted by histological damage at ANCA-GN diagnosis.
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Affiliation(s)
- Benoit Brilland
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Charlotte Boud'hors
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | - Marie-Christine Copin
- Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France.,Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Pierre Jourdain
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Nicolas Henry
- Service de Néphrologie-Dialyse, CH de Laval, Laval, France
| | - Samuel Wacrenier
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Service de Néphrologie-Dialyse, CH du Mans, Le Mans, France
| | - Assia Djema
- Service de Néphrologie-Dialyse, CH de Cholet, Cholet, France
| | - Clément Samoreau
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | | | - Maud Cousin
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jeremie Riou
- Micro et Nanomedecines Translationnelles, MINT, Université d'Angers, Unité Mixte de Recherche (UMR) Institut National de la Santé Et de la Recherche Médicale (INSERM) 6021, Unité Mixte de Recherche (UMR) Centre National de la Recherche Scientifique (CNRS) 6021, Angers, France.,Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, Angers, France
| | - Anne Croue
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-Paul Saint-André
- Service de Pathologie, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France
| | - Jean-François Subra
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
| | | | - Jean-François Augusto
- Service de Néphrologie-Dialyse-Transplantation, Université d'Angers, Centre Hospitalier Universitaire (CHU) Angers, Angers, France.,Université d'Angers, Université de Nantes, Centre Hospitalier Universitaire (CHU) d'Angers, Institut National de la Santé Et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCI2NA), Structure Fédérative de Recherche Interactions Cellulaires et Applications Thérapeutiques (SFR ICAT), Angers, France
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Manenti L, Urban ML, Maritati F, Galetti M, Vaglio A. Complement blockade in ANCA-associated vasculitis: an index case, current concepts and future perspectives. Intern Emerg Med 2017; 12:727-731. [PMID: 28191609 DOI: 10.1007/s11739-017-1636-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/06/2017] [Indexed: 01/30/2023]
Abstract
Complement alternative pathway (cAP) hyperactivation seems to be involved in ANCA-associated vasculitis (AAV). We here describe a case of AAV with severe activation of cAP that developed acute renal failure. No mutation predisposing to cAP dysregulation was identified. We treated our patient with the standard immunosuppressive therapy, but disease progression was only reversed after the addition of eculizumab, a monoclonal antibody against C5; the patient eventually achieved an almost complete renal function recovery. A review of the available literature about the role of complement targeted therapies in the treatment of AAV is discussed.
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Affiliation(s)
- Lucio Manenti
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy.
| | - Maria Letizia Urban
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Federica Maritati
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Maricla Galetti
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Augusto Vaglio
- Unità Operativa Complessa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126, Parma, Italy
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