Evaluation of prognostic factors for myeloperoxidase anti-neutrophil cytoplasmic antibody- (MPO-ANCA) associated glomerulonephritis

Aims: To identify prognostic factors for myeloperoxidase anti-neutrophil cy toplasmic antibody-(MPO-ANCA) associated glomerulonephritis. Materials: We analyzed the relations between the clinical and histological features of MP O-ANCA-associated glomerulonephritis and clinical outcome in 14 patients wi th the disease. The patients were divided into two groups: group 1 consiste d of 5 patients with progressive deterioration of renal function leading to endstage renal disease or chronic dialysis, group 2 consisted of 9 patient s in whom the initial deterioration of renal function had improved by the t ime of the final examination. Results: Creatinine clearance at the time of biopsy was significantly lower in group 1 than in group 2, and urinary prot ein was higher. The mean interval between onset of symptoms and biopsy in b oth groups was almost the same. Recovery of renal function was correlated w ith the percentage of global sclerosis, but patients who had severe crescen t formation did not always have a poor response to steroid therapy. There w as no statistical difference between the two groups in treatment regimens. Four patients required hemodialysis at the time of biopsy (3 in group 1 and 1 in group 2). Plasmapheresis was performed in 5 patients (1 in group 1 an d 4 in group 2). Conclusions: Degree of proteinuria. and renal dysfunction are indicators of a poor prognosis in MPO-ANCA-associated glomerulonephriti s. Global sclerosis is a histological feature that is an indicator of a poo r prognosis, whereas cellular crescent formation is a predictor of a good r esponse to steroid therapy.