In Japan, the significantly lower frequency of crescentic and relatively higher frequency of focal cases were noted; this might be partly attributed to the earlier intervention of renal biopsy after discovering a urinary or renal function abnormality in Japan. The relatively low creatinine level of the focal group in Japan compared with that of the same LCL161 group in China might support this tendency. As the progression of renal injury tends to be different between MPA and GPA, comparisons should be performed only between MPA in Europe and in Japan. This was not possible in this classification study because there were no data on the ratio of MPA in the crescentic group in Europe. In this study,
the Kaplan–Meier curve revealed the highly favorable prognosis of the mixed group. This indicates that the prognosis of this group is attributed to additional pathological parameter such as tubulointerstitial or vascular lesions nominated previously in Europe and Japan. At present, at least for MPA-oriented Defactinib in vivo cohorts in Japan, this classification only by glomerular parameters might be insufficient to predict the probability of progressing to ESRD. The comparison of European, Japanese and Chinese cohorts would be highly informative. The similarity of the GPA/MPA ratio between Europe and China in contrast JQEZ5 chemical structure to that of MPO-ANCA dominancy between Japan and China indicates that many GPA are MPO-ANCA-positive
in China, as Chinese authors have stated. The GPA dominancy might be attributed partly to the localization of the center at a high latitude, which has been reported to be related to the high prevalence of GPA . Although the numbers in the four categories were similar between Europe and China, there was a difference in the order of the increase of probability of progressing to ESRD between mixed and crescentic. The significantly more favorable prognosis of mixed than crescentic in China is similar to Japan, where Mannose-binding protein-associated serine protease both focal and mixed rarely showed progress to ESRD. In conclusion, the mixed group in
the new classification has high heterogenicity of histological activity and chronicity, which shows the insufficiency of this classification for prediction of the probability of progressing to ESRD. Re-evaluation of the predictive value by adding other parameters such as interstitial or vascular lesions for MPA-oriented cohorts is expected. Acknowledgments This study was supported in part by a Grant-in-Aid for Progressive Renal Diseases Research, Research on Intractable Disease from the Ministry of Health, Labor, and Welfare of Japan. Conflict of interest There is no conflict of interest in the preparation and submission of this manuscript. Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. References 1.