Evaluation of the Berden Classification and ANCA Kidney Risk Score in Biopsy-Proven ANCA-Associated Glomerulonephritis: Associations with Clinical Characteristics and Outcomes.

Authors

Erdem Baran, Arzu Ozdemir, Murvet Yilmaz

Published in

International journal of general medicine. Volume 19. Pages 641346. Epub Oct 12, 2026.

Abstract

This study aimed to evaluate the associations of the Berden histopathological classification and the ANCA Renal Risk Score (ARRS) with renal outcomes and overall survival in patients with biopsy-proven ANCA-associated glomerulonephritis.
This retrospective study included 54 adult patients with ANCA-associated vasculitis and biopsy-proven renal involvement between June 2016 and June 2023. Renal biopsies were categorized according to the Berden classification, and patients were stratified into low-, medium-, and high-risk groups according to the ARRS. Clinical, laboratory, treatment, renal outcome, and survival data were compared across the classification groups. Overall survival was assessed using Kaplan-Meier analysis and Cox proportional hazards regression.
Among 54 patients, 33.3% were classified as crescentic, 31.5% as focal, 20.4% as mixed, and 14.8% as sclerotic according to the Berden classification; 14.8%, 46.3%, and 38.9% were categorized as low-, medium-, and high-risk according to the ARRS, respectively. Baseline serum creatinine differed significantly across both Berden classes (p=0.025) and ARRS categories (p=0.035). Progression to end-stage renal disease (ESRD) also differed significantly across Berden classes (p=0.046) and ARRS categories (p=0.012), with the highest frequencies observed in the sclerotic class (50.0%) and high-risk ARRS group (33.3%). All eight ESRD events occurred in patients with baseline eGFR <15 mL/min/1.73 m² (27.6% vs 0% among those with eGFR ≥15 mL/min/1.73 m²; p=0.005). In contrast, mortality did not differ significantly across either classification system. Kaplan-Meier analysis showed no significant differences in overall survival across Berden classes (log-rank p=0.657) or ARRS categories (log-rank p=0.892). Neither classification system was independently associated with mortality in multivariable Cox regression.
The Berden classification and ARRS were associated with renal disease severity and progression to ESRD but not with overall survival in this cohort. Severe renal dysfunction at presentation, particularly an eGFR <15 mL/min/1.73 m², was strongly associated with subsequent ESRD. These findings support the utility of renal histopathological and clinical risk stratification for kidney-specific outcomes while highlighting their limited ability to predict overall mortality.

PMID:
42891350
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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