Bajema IM, Hagen EC, Hermans J, Noel LH, Waldherr R, Ferrario
F, van der Woude FJ, Brujin JA
Predicting renal outcome in systemic vasculitis from the kidney
biopsy: a clinicopathologic study of 157 patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1770 1996
The ability to predict disease outcome is one of the fundamental
purposes of renal biopsies, besides documenting a diagnosis to guide
therapeutic decisions. This challenge is particularly crucial in the
case of the systemic vasculitides in which the therapeutic choices
include drugs that can cause considerable morbidity if not used
judiciously. Any prognostic information provided by the biopsy is
thus incorporated in making decisions about how aggressively to treat.
Traditionally attention has focused on activity and chronicity
indices. Bajema et al. suggest that more attention should be given
to explicitly making a statement in reports of renal biopsies about
the proportion of residual intact glomeruli.
This was a prospective multicenter European study correlating glomerular
and tubulointerstitial findings with serum creatinine at the time of
biopsy and during follow-up. The study involved 157 cases of systemic
vasculitis and is an extension of a study of 83 patients published in
abstract form last year in the same forum
(Bajema IM et al.
JASN 1995;6:918). Both studies found that of all the
histopathological parameters, the percentage of normal glomeruli
correlated most significantly with serum creatinine both at the time
of biopsy and on follow-up.
Comment: The conclusion of the authors that the percent
of normal glomeruli be used to predict outcome in systemic
vasculitides is eminently logical. Their observation is interesting
enough that attempts to confirm it by others would be worthwhile. It
would be interesting also to attempt to extend it to biopsies of
patients with lupus nephritis. The one shortcoming of the abstract is
that no attempt was made to present the data, although some data were
presented in last year's abstract.
As a general comment, it would be good if a structured abstract format
as used now by the New England Journal of Medicine and JAMA was made
mandatory so that investigators provide us with enough information to
evaluate their work without necessarily having to either meet them
face to face at the poster sessions or the oral presentations;
something which is impossible with the meeting's program being now as
crowded as it is. (Samy S. Iskandar, MBBCh, PhD, Bowman Gray
School of Medicine, Winston-Salem, NC)
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Am Soc Nephrol
Proteinuria/Hematuria :
Vasculitis (Wegener's PAN, etc.)