Zdenka Hruskova1, Eva Honsova2, Annelies E Berden3, Ivan Rychlik4, Vera Lanska5, Jiri Zabka6, Ingeborg M Bajema3, Vladimir Tesar1. 1. Department of Nephrology, General University Hospital and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. 2. Department of Pathology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 3. Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands. 4. 2nd Department of Internal Medicine, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. 5. Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. 6. 1st Department of Internal Medicine, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Abstract
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.
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 AAVpatients 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 AAVpatients have grumbling disease with ongoing activity, eventually leading to an increased amount of chronic lesions.
Authors: Duvuru Geetha; Sanjeev Sethi; An S De Vriese; Ulrich Specks; Cees G M Kallenberg; Noha Lim; Robert Spiera; E William St Clair; Peter A Merkel; Philip Seo; Paul A Monach; Nicola Lepori; Barri J Fessler; Carol A Langford; Gary S Hoffman; Rishi Sharma; John H Stone; Fernando C Fervenza Journal: Am J Nephrol Date: 2017-09-08 Impact factor: 3.754