Repeat protocol renal biopsy in ANCA-associated renal vasculitis
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
24578468
DOI
10.1093/ndt/gfu042
PII: gfu042
Knihovny.cz E-resources
- Keywords
- ANCA, outcome, rebiopsy, renal biopsy, vasculitis,
- MeSH
- Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis pathology MeSH
- Biopsy methods MeSH
- Adult MeSH
- Kidney Glomerulus pathology MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Clinical Protocols MeSH
- Kidney pathology MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Kidney Diseases pathology MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Severity of Illness Index MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Names of Substances
- Immunosuppressive Agents MeSH
BACKGROUND: Histopathological lesions in renal biopsy (RB) at presentation of ANCA-associated vasculitis (AAV) have been described in depth but repeat protocolized renal biopsies are seldomly performed in AAV. In this study, we present a group of AAV patients with repeat protocolized biopsies, and we evaluate their clinical significance. METHODS: A total of 17 consecutive patients diagnosed between 1991 and 1995 with AAV and renal involvement confirmed by biopsy at presentation in a single center underwent a protocol planned rebiopsy in remission after a median of 13 months (range 11-28) from diagnosis. Biopsies were assessed by two independent pathologists, blinded to patient data. Clinical data were collected retrospectively. RESULTS: Patients were followed-up for a median of 189 months from diagnosis. Renal relapse was observed in eight patients (47.1%), seven patients died, three patients reached end-stage renal failure. There was a significant decrease in the percentage of acute lesions (cellular crescents, fibrinoid necrosis, P < 0.001) and a significant increase in chronic lesions (glomerulosclerosis, interstitial fibrosis, P ≤ 0.01) in the repeat RB compared with the first RB. This resulted in a class change over the biopsies within most patients. The percentage of normal glomeruli in the first biopsy positively correlated with estimated GFR at the end of follow-up (rs = 0.509, P = 0.05). CONCLUSIONS: This is the first study on protocolized repeat biopsies in AAV, giving insight into disease activity under immunosuppressive treatment. Apparently, many AAV patients have grumbling disease with ongoing activity, eventually leading to an increased amount of chronic lesions.
Department of Pathology Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Pathology Leiden University Medical Center Leiden The Netherlands
Statistical Unit Institute for Clinical and Experimental Medicine Prague Czech Republic
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