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Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case-control study.

Yang YZ, Shi SF, Chen YQ, Chen M, Yang YH, Xie XF, Zou R, Lv JC, Liu LJ, Zhang H - Clin Kidney J (2015)

Bottom Line: Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003).After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients.However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients.

View Article: PubMed Central - PubMed

Affiliation: Renal Division, Key Laboratory of Renal Disease, Ministry of Health of China , Peking University First Hospital, Institute of Nephrology, Peking University , Beijing , PR China.

ABSTRACT

Background: The coexistence of IgA nephropathy (IgAN) and antineutrophil cytoplasmic autoantibodies (ANCAs) is relatively rare. Only a few studies have reported the features of these patients.

Methods: We studied the clinical and histological features of 20 ANCA-positive IgAN patients. They were compared with ANCA-negative IgAN patients (n = 40) and ANCA-associated systemic vasculitis (AASV) patients (n = 40) with a randomly selected and matched proportion of crescentic glomeruli. Furthermore, 9 ANCA-positive crescentic IgAN patients out of the 20 cases were compared with two control groups with crescentic nephritis.

Results: ANCA-positive IgAN patients showed older age, lower haemoglobin and higher inflammatory indicator levels at baseline, and a higher percentage of general symptoms and pulmonary involvement, compared with ANCA-negative IgAN patients, and were comparable to AASV patients. Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003). After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients.

Conclusions: IgAN patients with ANCA positivity showed more severe clinical and histological features when compared with ANCA-negative IgAN patients and were comparable to AASV patients. However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients.

No MeSH data available.


Related in: MedlinePlus

ESRD in ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. ANCA, antineutrophil cytoplasmic autoantibody; IgAN, IgA nephropathy; AASV, ANCA-associated systemic vasculitis; ESRD, end-stage renal disease.
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SFV078F1: ESRD in ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. ANCA, antineutrophil cytoplasmic autoantibody; IgAN, IgA nephropathy; AASV, ANCA-associated systemic vasculitis; ESRD, end-stage renal disease.

Mentions: In this study, 1.2% (20/1729) of IgAN patients showed ANCA-positivity, including nine with crescentic glomerulonephritis (>50% crescentic glomeruli). Tables 1 and 2 and Figure 1 show the comparison of clinical and histological data, response to therapy and prognosis among ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. The details of pulmonary involvement and coexistence with other autoimmune disease in ANCA-positive IgAN patients are shown in the Supplementary data.Table 1.


Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case-control study.

Yang YZ, Shi SF, Chen YQ, Chen M, Yang YH, Xie XF, Zou R, Lv JC, Liu LJ, Zhang H - Clin Kidney J (2015)

ESRD in ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. ANCA, antineutrophil cytoplasmic autoantibody; IgAN, IgA nephropathy; AASV, ANCA-associated systemic vasculitis; ESRD, end-stage renal disease.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581394&req=5

SFV078F1: ESRD in ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. ANCA, antineutrophil cytoplasmic autoantibody; IgAN, IgA nephropathy; AASV, ANCA-associated systemic vasculitis; ESRD, end-stage renal disease.
Mentions: In this study, 1.2% (20/1729) of IgAN patients showed ANCA-positivity, including nine with crescentic glomerulonephritis (>50% crescentic glomeruli). Tables 1 and 2 and Figure 1 show the comparison of clinical and histological data, response to therapy and prognosis among ANCA-positive IgAN, ANCA-negative IgAN and AASV patients with matched proportions of crescentic glomeruli. The details of pulmonary involvement and coexistence with other autoimmune disease in ANCA-positive IgAN patients are shown in the Supplementary data.Table 1.

Bottom Line: Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003).After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients.However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients.

View Article: PubMed Central - PubMed

Affiliation: Renal Division, Key Laboratory of Renal Disease, Ministry of Health of China , Peking University First Hospital, Institute of Nephrology, Peking University , Beijing , PR China.

ABSTRACT

Background: The coexistence of IgA nephropathy (IgAN) and antineutrophil cytoplasmic autoantibodies (ANCAs) is relatively rare. Only a few studies have reported the features of these patients.

Methods: We studied the clinical and histological features of 20 ANCA-positive IgAN patients. They were compared with ANCA-negative IgAN patients (n = 40) and ANCA-associated systemic vasculitis (AASV) patients (n = 40) with a randomly selected and matched proportion of crescentic glomeruli. Furthermore, 9 ANCA-positive crescentic IgAN patients out of the 20 cases were compared with two control groups with crescentic nephritis.

Results: ANCA-positive IgAN patients showed older age, lower haemoglobin and higher inflammatory indicator levels at baseline, and a higher percentage of general symptoms and pulmonary involvement, compared with ANCA-negative IgAN patients, and were comparable to AASV patients. Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003). After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients.

Conclusions: IgAN patients with ANCA positivity showed more severe clinical and histological features when compared with ANCA-negative IgAN patients and were comparable to AASV patients. However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients.

No MeSH data available.


Related in: MedlinePlus