The Prognostic Value of Histopathological Classifications in ANCA-Associated Vasculitis

• Autor(a) principal: Alves,Patrícia
• Data de Publicação: 2022
• Outros Autores: Góis,Mário
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692022000400260
• topic: Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/pathology; Glomerulonephritis; Kidney Diseases; Prognosis; Risk Assessment

ABSTRACT Renal involvement is a common and severe feature of ANCA-associated vasculitis, leading to end-stage kidney disease and death in a considerable number of patients. One of the challenges of ANCA-associated glomerulonephritis is to establish histological features of prognostic value, in order to identify patients who will benefit of immunosuppression. Although the prognostic value of the renal biopsy in ANCA-associated glomerulonephritis is widely recognized, there is no consensus regarding its pathologic classification. In 2010, Berden et al (J Am Soc Nephrol. 2010; 21: 1628-36) proposed a histopathologic classification based only on glomerular morphology, which is of prognostic value for short-term and long-term renal outcomes. However, over the last years, the results of several studies using multivariable approaches have suggested that the proposed histopathologic classes alone might not be sufficient to predict renal outcome. In order to refine the prognosis of patients with ANCA-associated vasculitis, in 2018, Brix et al (Kidney Int. 2018;94:1177-88) proposed the Renal Risk Score, based on clinical and pathological parameters. In this review, we discuss the prognostic value of the Histopathologic Classification and the Renal Risk Score and their role in routine clinical practice.