Predicting long-term renal and patient survival by clinicopathological features in elderly patients undergoing a renal biopsy in a UK cohort

Navaratnarajah, Arunraj; Sambasivan, K.; Cook, Terry; Pusey, Charles D.; Roufosse, Candice; Willicombe, Michelle

doi:10.1093/ckj/sfz006

Cited by 15 publications

(10 citation statements)

References 25 publications

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“…22 Performing a kidney biopsy in the elderly, a population with a rising incidence of AAV, has also been shown to be safe and to provide important prognostic information for these patients. 24 We recognize the limitations of our study. Its retrospective nature and inclusion of patients from a single tertiary AAV referral centre.…”

Section: Discussionmentioning

confidence: 82%

Utility of interval kidney biopsy in ANCA-associated vasculitis

et al. 2021

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Objectives Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disorder that commonly involves the kidney. Early identification of kidney involvement, assessing treatment-response and predicting outcome are important clinical challenges. Here, we assessed the potential utility of interval kidney biopsy in AAV. Methods In a tertiary referral centre with a dedicated vasculitis service, we identified patients with AAV who had undergone interval kidney biopsy, defined as a repeat kidney biopsy (following an initial biopsy showing active AAV) undertaken to determine the histological response in the kidney following induction immunosuppression. We analysed biochemical, histological and outcome data, including times to kidney failure and death for all patients. Results We identified 57 patients with AAV who underwent at least one interval kidney biopsy (59 interval biopsies in total; median time to interval biopsy ∼130 days). Of the 59 interval biopsies performed, 24 (41%) patients had clinically suspected active disease at time of biopsy which was confirmed histologically in only 42% of cases; 35 (59%) patients were in clinical disease-remission, and this was correct in 97% of cases. The clinician’s impression was incorrect in 1 in 4 patients. Hematuria at interval biopsy did not correlate with histological activity. Interval biopsy showed fewer acute lesions and more chronic damage compared to initial biopsy and led to immunosuppressive treatment-change in 75% (44/59) of patients. Clinical risk prediction tools tended to operate better using interval biopsy data. Conclusion Interval kidney biopsy is useful for determining treatment-response and subsequent disease management in AAV. It may provide better prognostic information than initial kidney biopsy and should be considered for inclusion into future clinical trials and treatment protocols for patients with AAV.

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Section: Discussionmentioning

confidence: 82%

Utility of interval kidney biopsy in ANCA-associated vasculitis

et al. 2021

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“…The phenotype of nephropathy was determined according to histological methods, as previously described. [ 12 ] The types of nephropathy diagnosed in this study included MN, focal segmental glomerulosclerosis (FSGS), IgA nephropathy (IgA-N), mesangial proliferative glomerulonephritis (MsPGN), and minimal change nephropathy (MCN). In our study, a diagnosis of AITD, which involved HT and GD, was made based on clinical examination, thyroid ultrasound, and titration of TG-Ab, TPO-Ab, and thyroid-stimulating hormone (TSH) receptor antibody (TSHR-Ab), as previously described.…”

Section: Methodsmentioning

confidence: 99%

Relationship between autoimmune thyroid disease and nephropathy

Zhao

Liu

et al. 2021

Medicine

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The association of nephropathy with autoimmune thyroid disease (AITD) has been reported previously. However, there is limited information on the relationship between thyroid autoantibodies and nephropathy. A retrospective study was conducted using the medical records of 246 patients with nephropathy, 82 of whom had concurrent AITD. General characteristics, thyroid function, autoantibodies, and the pathological types of nephropathy were analyzed. Immunohistochemistry was used to detect the thyroglobulin antibody (TG-Ab) and thyroid peroxidase antibody (TPO-Ab) in the kidneys. We found nephropathy patients with AITD exhibited higher serum levels of TPO-Ab, TG-Ab, thyroid-stimulating hormone receptor antibody (TR-Ab), and immunoglobulin G (IgG) ( P < .05). Compared with the nephropathy without AITD group, the nephropathy with AITD group exhibited higher proportions of membranous nephropathy (MN) and focal segmental glomerulosclerosis (FSGS), and relatively lower proportions of mesangial proliferative glomerulonephritis (MsPGN) and minimal change nephropathy (MCN) ( P = .005). TPO-Ab and TG-Ab levels in the kidney were more prevalent in nephropathy patients with AITD than those without AITD ( P = .015 and P = .026, respectively). Subgroup analysis demonstrated that serum levels of thyroid stimulating hormone (TSH), TG-Ab, TPO-Ab, immunoglobulin M (IgM), and IgG in the MN group were significantly higher, whereas the levels of free thyroxine (FT4) and estimated glomerular filtration rate (eGFR) were lower, as compared with MN with Hashimoto thyroiditis (HT) group ( P < .05). TPO-Ab and TG-Ab expression levels in the kidneys were more prevalent in the MN group than in the MN with HT group ( P = .034). The expression levels of FT4, TG-Ab, TPO-Ab, and thyroid-stimulating hormone receptor antibody (TSHR-Ab) in the serum were significantly higher in the MN group than in the MN with Graves disease (GD) group ( P < .05). The expression of TPO-Ab in the kidneys was more prevalent in the MN group than in the MN with GD group ( P = .011). In sum, the expressions of TPO-Ab and TG-Ab were more prevalent in the kidneys of patients with nephropathy and AITD. Our findings indicate that TPO-Ab and TG-Ab may play a role in the development of AITD-related nephropathy.

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“…Older age was previously related to inferior patient survival among patients that required a renal biopsy [36]. In our cohort, older age and the presence of hypertension were significant risk factors for patient survival.…”

Section: Plos Onementioning

confidence: 55%

Idiopathic membranous nephropathy in older patients: Clinical features and outcomes

et al. 2020

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Background Various factors can affect renal and patient outcome in idiopathic membranous nephropathy (iMN). We aimed to identify predictors of renal and patient survival in patients with iMN, with a special focus on outcomes among older patients. Methods We retrieved data on 1,776 patients (mean age 53.0 ± 14.7 years; 1,075 [60.5%] males) diagnosed with iMN from the Korean GlomeruloNEphritis sTudy (KoGNET), a database compiled from 18 centers in Korea. Results The cohort included 428 (24.1%) patients over 65 years old. Compared to younger patients, this group had lower hemoglobin and serum albumin levels, a higher incidence of nephroticrange proteinuria, and higher prevalences of hypertension and diabetes. At last follow-up, complete or partial remission rates were not significantly different between the older and younger groups. Older age (HR: 0.98, 95%CI: 0.97-0.99), elevated hemoglobin (HR: 0.82, 95%CI: 0.72-0.93), high serum albumin (HR: 0.66, 95%CI: 0.44-0.99), and a high estimated glomerular filtration rate (HR: 0.96, 95%CI: 0.95-0.97) at biopsy were good predictors of renal outcomes. Significant risk factors for patient survival were older age (HR: 1.04, 95%CI: 1.01-1.10) and hypertension at biopsy (HR: 2.76, 95%CI: 1.30-5.90). Conclusions Older patients with iMN had favorable renal outcomes, but poor patient survival, compared to younger patients. Prognostic information on outcomes in this study might be helpful for optimizing the management of patients with iMN.

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Predicting long-term renal and patient survival by clinicopathological features in elderly patients undergoing a renal biopsy in a UK cohort

Cited by 15 publications

References 25 publications

Utility of interval kidney biopsy in ANCA-associated vasculitis

Utility of interval kidney biopsy in ANCA-associated vasculitis

Relationship between autoimmune thyroid disease and nephropathy

Idiopathic membranous nephropathy in older patients: Clinical features and outcomes

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