CLINICAL CASE 28, ANSWERS AND SUMMARY

Based on the newly proposed histopathologic classification for ANCA associated Glomerulonephritis, which one of the following is NOT a class?

Focal	5 (35%)
Mixed	0 (0%)
Fibrous	6 (42%)
Crescentic	0 (0%)
Sclerotic	3 (21%)

Most of you said fibrous as a choice.  Recently, a working group of pathologist and nephrologist have come up with a classification schema for ANCA associated GNs.  This proposed classification is based on pathology on LM.  

The classification is simple based on percentage of sclerosis.  

If there is >50% globally sclerotic glomeruli  ---> Sclerotic Class
If Not >50% sclerotic glomeruli and there is >50% normal glomeruli ---> focal Class

If Not >50% sclerotic glomeruli and Not >50% normal glomeruli but >50% cellular crescents ---> Crescentic Class

If Not >50% sclerotic glomeruli and Not >50% normal glomeruli and Not >50% celluler crescents---> mixed class.

Fibrous is not a category. The above classification had some clinical correlation and hence was proposed.

The focal class has the best renal outcome and hence might respond better to treatment

Crescentic class had severe renal disease but could respond well to treatment as well

Patients with mixed class had intermediate outcome

Patients with sclerotic class had the worse outcome and perhaps higher risk of death within the first year? Perhaps not treating might be better?

Take a look:

http://www.ncbi.nlm.nih.gov/pubmed/20616173