Risk Factors for Renal Survival in Chinese Patients with Myeloperoxidase-ANCA–Associated GN

Background and objectives Our study explored the association of histopathologic classification of ANCA-associated GN with renal survival in Chinese patients with myeloperoxidase-ANCA–associated GN. Design, setting, participants, & measurements Two hundred fifteen patients with biopsy-proven myeloperoxidase-ANCA–associated GN were included from January of 1996 to December of 2014. The biopsies included focal ( n =27), mixed ( n =82), crescentic ( n =47), and sclerotic ( n =59) classes. The long-term renal outcome and risk factors of myeloperoxidase-ANCA–associated GN for different histopathologic classes were retrospectively analyzed. Results During a median follow-up time of 22 (9–51) months, 88 (40.9%) patients reached ESRD. The 5-year renal survival (overall 58.7%) was highest in the focal class (100.0%) and lowest in the sclerotic class (20.7%), with no difference between the mixed (58.9%) and crescentic (67.4%) classes. Patients in the mixed (hazard ratio, 0.34; 95% confidence interval, 0.20 to 0.57; P P P P P =0.002) were at higher risk for ESRD. A serum creatinine level ≥4 mg/dl and a percentage of global sclerotic glomeruli ≥60% were the two independent risk factors for ESRD in the sclerotic class. Conclusions The histopathologic classification of ANCA-associated GN in combination with serum creatinine and serum albumin levels and treatment regimen is associated with renal outcome in myeloperoxidase-ANCA–associated GN. The evaluation of serum creatinine level and percentage of global sclerotic glomeruli provides additional information on the risk of renal survival in the sclerotic class of myeloperoxidase-ANCA–associated GN.