In:
Journal of the American Society of Nephrology, Ovid Technologies (Wolters Kluwer Health), ( 2023-12-12)
Kurzfassung:
Reliable prediction tools are needed to personalize treatment in anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis. A retrospective international longitudinal cohort was collated to revise the ANCA Renal Risk Score (ARRS). Methods: The primary endpoint was end-stage kidney disease with patients censored at last follow-up. Cox Proportional Hazards were used to reweight risk factors. Kaplan-Meier curves, Harrell’s C statistic, Receiver Operating Characteristics and calibration plots were used to assess model performance. Results: Of 1591 patients, 1439 were included in the final analyses, 2:1 randomly allocated per centre to development and validation cohorts (52% male, median age 64 years). In the development cohort (n=959), the ARRS was validated, calibrated and parameters were reinvestigated modifying interstitial fibrosis and tubular atrophy (IFTA) allowing semiquantitative reporting. An additional cut-off for kidney function (K) was identified and serum creatinine replaced glomerular filtration rate (K0: 〈 250 μmol/l = 0, K1: 250-450 μmol/l = 4, K2: 〉 450 μmol/l = 11 points). The risk points for the percentage of normal glomeruli (N) and IFTA (T) were reweighted (N0: 〉 25% = 0, N1: 10-25% = 4, N2: 〈 10% = 7, T0: none/mild or 〈 25% = 0, T1: ≥ mild-moderate or ≥ 25% = 3 points), and four risk groups created: low (0 – 4 points), moderate (5 – 11), high (12 – 18) and very high (21). Discrimination was C=0.831, and the three-year kidney survival was 96%, 79%, 54%, and 19%, respectively. The revised score performed similarly well in the validation cohort with excellent calibration and discrimination (n=480, C=0.821). Conclusion: The updated score optimizes clinicopathologic prognostication for clinical practice and trials.
Materialart:
Online-Ressource
ISSN:
1046-6673
,
1533-3450
DOI:
10.1681/ASN.0000000000000274
Sprache:
Englisch
Verlag:
Ovid Technologies (Wolters Kluwer Health)
Publikationsdatum:
2023
ZDB Id:
2029124-3
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