Berden et al reported a histopathologic classification for ANCA-associated glomerulonephritis. These changes impact the patient's prognosis. The authors are from multiple institutions in Europe and Japan and the United States.
Patient selection: ANCA-associated glomerulonephritis
Normal glomeruli:
(1) may show subtle ischemic changes
(2) < 4 white blood cells
(3) without synechiae
(4) without focal or global glomerulosclerosis
(5) without vasculitis
(6) without extensive ischemic changes, such as distortion of the basement membrane
Parameters:
(1) total number of glomeruli
(2) percent of the glomeruli that are normal
(3) percent of glomeruli showing crescents
(4) percent of glomeruli showing global glomerulosclerosis (> 80% of the glomerulus is sclerosed)
Crescents may be classified as cellular or fibrotic.
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Normal
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Cellular Crescents
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Globally Sclerotic
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Classification
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>= 50%
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focal
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>= 50%
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crescentic
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>= 50%
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sclerotic
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< 50%
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< 50%
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< 50%
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mixed
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Renal function tends to be better for focal disease and worst for sclerotic.
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Classification
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8-Year Renal Survival
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focal
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93%
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crescentic
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74%
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sclerotic
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29%
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mixed
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52%
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