Kidney Outcomes in ANCA-Glomerulonephritis According to Induction Immunosuppression and Histopathology

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Introduction Cyclophosphamide (CYC) and rituximab (RTX), alone or combined, are the mainstays of induction therapy in ANCA-glomerulonephritis. It is unknown whether the response to induction is differentially affected by kidney histopathology. Methods This is a retrospective, multicenter study including patients with biopsy-proven ANCA-glomerulonephritis. Cases were grouped according to the Berden nephropathology classification. eGFR recovery at 6 months was defined as eGFR increase≥15ml/min/1.73m 2 or discontinuation of kidney replacement therapy; kidney failure was defined as sustained eGFR<15mL/min/1.73m 2 or long-term kidney replacement therapy. Multivariable regression models were used to explore independent predictors of kidney outcomes across Berden classes. Result TThe cohort included 304 patients; median baseline eGFR was 20ml/min/1.73m 2 (IQR 11-35). Induction immunosuppression was CYC in 59%, RTX in 17% and RTX-CYC in 24%. Overall, 50% recovered kidney function and 19.4% had kidney failure over a median follow-up of 42 months(IQR 18-72). In the crescentic class, the RTX group had lower chances of eGFR recovery than CYC (OR 0.23, 95%CI 0.05-0.98, p=0.047); the trend was similar in comparison with RTX-CYC (OR 0.20, 95%CI 0.03-1.19, p=0.077). In the crescentic class, RTX monotherapy was marginally associated with increased risk of kidney failure, compared to both CYC (HR 3.42,95%CI 1.03-11.35, p=0.045) and RTX-CYC (HR 5.33,95%CI 0.91-31.18, p=0.063). No significant differences were observed in the other Berden classes. Conclusions TPatients with crescentic class ANCA-glomerulonephritis receiving RTX monotherapy may have worse kidney outcomes than those treated with CYC-based regimens. Further studies are needed to validate these results and better understand how to personalize treatment.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.