Abstract
We investigated the association of antineutrophil cytoplasmic antibody (ANCA) positivity with lupus nephritis (LN) activity, histological features and prognosis in Korean patients with biopsy-proven LN having the results of both myeloperoxidase (MPO–ANCA) and proteinase 3 (PR3)–ANCA. We retrospectively reviewed the medical records of 91 LN patients having the results of ANCA. We divided patients with LN into the two groups according to the ANCA positivity. We collected clinical and laboratory data at kidney biopsy and histological features such as LN class including class I, II, III, IV-S, IV-G and V, and activity and chronicity index. We evaluated prognosis of LN during the follow-up by death and kidney failure. Twelve of 91 patients (13.2%) had ANCA at kidney biopsy. There were no differences in demographic data, comorbidities, reasons for kidney biopsy and laboratory data at kidney biopsy between patients with and without ANCA. In 12 LN patients with ANCA, Class III was the most frequently observed LN class (41.7%), while in 79 LN patients without ANCA, class IV-G was the most often detected LN class (35.4%). There were no meaningful differences in classes of LN between the two groups. On the other hand, patients with ANCA exhibited the higher median chronicity index than those without (2.5 vs. 1.0, P = 0.028), unlike activity index. ANCA positivity exhibited no association with death or kidney failure during the follow-up. ANCA positivity at kidney biopsy is associated with chronicity index of LN.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
van Vollenhoven RF, Mosca M, Bertsias G, Isenberg D, Kuhn A, Lerstrom K et al (2014) Treat-to-target in systemic lupus erythematosus: recommendations from an international task force. Ann Rheum Dis 73:958–967
Gordon C, Jayne D, Pusey C, Adu D, Amoura Z, Aringer M et al (2009) European consensus statement on the terminology used in the management of lupus glomerulonephritis. Lupus 18:257–263
Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB et al (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15:241–250
Tesar V, Hruskova Z (2011) Treatment of proliferative lupus nephritis: a slowly changing landscape. Nat Rev Nephrol 7:96–109
Ortega LM, Schultz DR, Lenz O, Pardo V, Contreras GN (2010) Review: Lupus nephritis: pathologic features, epidemiology and a guide to therapeutic decisions. Lupus 19:557–574
Cui Z, Zhao MH, Segelmark M, Hellmark T (2010) Natural autoantibodies to myeloperoxidase, proteinase 3, and the glomerular basement membrane are present in normal individuals. Kidney Int 78:590–597
Jennette JC, Falk RJ (2014) Pathogenesis of antineutrophil cytoplasmic autoantibody-mediated disease. Nat Rev Rheumatol 10:463–473
Hill GS, Delahousse M, Nochy D, Bariety J (2005) Class IV-S versus class IV-G lupus nephritis: clinical and morphologic differences suggesting different pathogenesis. Kidney Int 68:2288–2297
Turner-Stokes T, Wilson HR, Morreale M, Nunes A, Cairns T, Cook HT et al (2017) Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy. Kidney Int 92:1223–1231
Wang Y, Huang X, Cai J, Xie L, Wang W, Tang S et al (2016) Clinicopathologic characteristics and outcomes of lupus nephritis with antineutrophil cytoplasmic antibody: a retrospective study. Medicine (Baltimore) 95:e2580
Charney DA, Nassar G, Truong L, Nadasdy T (2000) “Pauci-Immune” proliferative and necrotizing glomerulonephritis with thrombotic microangiopathy in patients with systemic lupus erythematosus and lupus-like syndrome. Am J Kidney Dis 35:1193–1206
Nasr SH, D’Agati VD, Park HR, Sterman PL, Goyzueta JD, Dressler RM et al (2008) Necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity. Clin J Am Soc Nephrol 3:682–690
Chan TM (2015) Treatment of severe lupus nephritis: the new horizon. Nat Rev Nephrol 11:46–61
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Lewis EJ, Schwartz MM (2005) Pathology of lupus nephritis. Lupus 14:31–38
Nossent HC, Henzen-Logmans SC, Vroom TM, Berden JH, Swaak TJ (1990) Contribution of renal biopsy data in predicting outcome in lupus nephritis. Analysis of 116 patients. Arthritis Rheum 33:970–977
Li C, Zhou ML, Liang DD, Wang JJ, Yang J, Zeng CH et al (2017) Treatment and clinicopathological characteristics of lupus nephritis with anti-neutrophil cytoplasmic antibody positivity: a case-control study. BMJ Open 7:e015668
Cordova-Sanchez BM, Mejia-Vilet JM, Morales-Buenrostro LE, Loyola-Rodriguez G, Uribe-Uribe NO, Correa-Rotter R (2016) Clinical presentation and outcome prediction of clinical, serological, and histopathological classification schemes in ANCA-associated vasculitis with renal involvement. Clin Rheumatol 35:1805–1816
Hauer HA, Bajema IM, van Houwelingen HC, Ferrario F, Noel LH, Waldherr R et al (2002) Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups. Kidney Int 61:80–89
Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F et al (2013) 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 65:1–11
Watts R, Lane S, Hanslik T, Hauser T, Hellmich B, Koldingsnes W et al (2007) Development and validation of a consensus methodology for the classification of the ANCA-associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 66:222–227
Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP et al (1990) The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 33:1094–1100
Koh JH, Kemna MJ, Cohen Tervaert JW, Kim WU (2016) Editorial: can an increase in antineutrophil cytoplasmic autoantibody titer predict relapses in antineutrophil cytoplasmic antibody-associated vasculitis? Arthritis Rheumatol 68:1571–1573
Funding
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2017R1D1A1B03029050).
Author information
Authors and Affiliations
Contributions
JYP and S-WL collected the data and analysed the results and wrote the manuscript, under the guidance of SMJ and JJS; Y-BP contributed to writing and critically reviewed the manuscript; JYP and SWL designed, analysed the results, critically reviewed the manuscript and wrote the final version. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
None.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the institutional Review Board of Severance Hospital (4-2017-0444).
Informed consent
The patient’s written informed consent was waived by the approving IRB, as this was a retrospective study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Pyo, J.Y., Jung, S.M., Song, J.J. et al. ANCA positivity at the time of renal biopsy is associated with chronicity index of lupus nephritis. Rheumatol Int 39, 879–884 (2019). https://doi.org/10.1007/s00296-019-04263-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-019-04263-2