RENHIS stands for Renal Histology. The RENHIS group first came together in Leiden in 1994 when renal biopsies from the EC/BCR study had to be systematically evaluated. A scoring form was devised, and inter- and intraobserver agreement was established.1 This scoring form has since then been used to evaluate renal biopsies from MEPEX, CYCAZAREM, and recentely, of RITUXVAS. Collection of MYCYC renal biopsies has recently started. Renal biopsies evaluated by EUVAS are scored by two pathologists, after which consensus meetings are organized to solve discrepant cases.
Results from renal histology studies initiated by EUVAS have shown that the percentage of normal glomeruli in renal biopsies of patients with ANCA-associated glomerulonephritis are an important prognostic parameter.2-3 In patients from MEPEX, normal glomeruli were a positive predictor of dialysis independence and improved renal function after 12 months.4 Normal glomeruli also came out as a factor to determine the chances of death over dialysis independence of MEPEX patients.5 In patients from CYCAZAREM, GFR at entry in combination with chronic renal lesions in the renal biopsies were important predictors of GFR at 18 months.6 Histomorphological differences in renal biopsies of patients with anti-PR3 ANCA and anti-MPO ANCA7 and the histology findings in a select group of follow-up biopsies from patients with ANCA-associated glomerulonephritis8 have been published. In patients from RITUXVAS, intra-epithelial T cell tubulitis proved predictive of short-term clinical outcomes as measured by serum creatinine level and time to remission. Further analyses of RITUXVAS patients are on their way.
1. Bajema IM, Hagen EC, Hansen BE, Hermans J, Noël LH, Waldherr R, Ferrario F, van der Woude FJ, Bruijn JA. The renal histopathology in systemic vasculitis: an international survey study of inter- and intra-observer agreement. Nephrol Dial Transplant. 1996, 11:1989-95
2. Bajema IM, Hagen EC, Hermans J, Noël LH, Waldherr R, Ferrario F, Van Der Woude FJ, Bruijn JA. Kidney biopsy as a predictor for renal outcome in ANCA-associated necrotizing glomerulonephritis. Kidney Int. 1999, 56:1751-8
3. Vergunst CE, van Gurp E, Hagen EC, van Houwelingen HC, Hauer HA, Noël LH, Waldherr R, Ferrario F, van der Woude FJ, Bruijn JA, Bajema IM; EC/BCR Project for ANCA-Assay Standardisation. An index for renal outcome in ANCA-associated glomerulonephritis. Am J Kidney Dis. 2003, 41:532-8.
4. de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R, Jayne DR, Gaskin G, Rasmussen N, Noel LH, Ferrario F, Waldherr R, Hagen EC, Bruijn JA, Bajema IM.Clinical and histologic determinants of renal outcome in ANCA-associated vasculitis: A prospective analysis of 100 patients with severe renal involvement. J Am Soc Nephrol. 2006, 17:2264-74.
5. de Lind van Wijngaarden RA, Hauer HA, Wolterbeek R, Jayne DR, Gaskin G, Rasmussen N, Noël LH, Ferrario F, Waldherr R, Bruijn JA, Pusey CD, Bajema IM, Hagen EC; EUVAS. Chances of renal recovery for dialysis-dependent ANCA-associated glomerulonephritis. J Am Soc Nephrol. 2007, 18:2189-97.
6. Hauer HA, Bajema IM, Van Houwelingen HC, Ferrario F, Noel LH, Waldherr R, Jayne DR, Rasmussen N, Bruijn JA, Hagen EC; European Vasculitis Study Group (EUVAS). Determinants of outcome in ANCA-associated glomerulonephritis: a prospective clinico-histopathological analysis of 96 patients. Kidney Int. 2002, 62:1732-42
7. Hauer HA, Bajema IM, van Houwelingen HC, Ferrario F, Noel LH, Waldherr R, Jayne DR, Rasmussen N, Bruijn JA, Hagen EC; European Vasculitis Study Group (EUVAS). Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups. Kidney Int. 2002, 61:80-9
8. Hauer HA, Bajema IM, Hagen EC, Noel LH, Ferrario F, Waldherr R, van Houwelingen HC, Lesavre P, Sinico RA, van der Woude F, Gaskin G, Verburgh CA, de Heer E, Bruijn JA: Long-term renal injury in ANCA-associated vasculitis: an analysis of 31 patients with follow-up biopsies. Nephrol Dial Transplant. 2002, 17:587-96