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Increased renal damage in hypocomplementemic patients with ANCA-associated vasculitis: retrospective cohort study

Abstract

Introduction

The complement system has an important role in the pathogenesis of vasculitis associated with antineutrophilic cytoplasmic antibody (AAV) mainly at the level of the kidneys because patients with complement deposits on the glomerular basal membrane present more aggressive disease compared with those with pauci-immune vasculitis.

Aim

To analyze the association of hypocomplementemia with the clinical manifestations, laboratory data, renal histology, progress to renal insufficiency, and mortality of patients with AAV.

Methods

Retrospective cohort study (2000–2007) included 93 patients with AAV. Hypocomplementemia is defined as having C3 values lower than 80 mg/dL or C4 values below 15 mg/dL. Demographic, statistical, clinical, hematological, serological, and histopathological characteristics of all the patients with and without diagnosis of hypocomplementemia were compared. In order to evaluate variable independence, a logistic regression analysis was used.

Results

Ninety-three patients were studied of whom 63 (67.7%) had complement dosage at the moment of AAV diagnosis. Seven patients (11.1%) presented hypocomplementemia and a greater kidney involvement compared with normocomplementemic patients. Thirty renal biopsies were analyzed and 4 (13.3%) showed immunocomplex (IC) or complement deposits by an immunofluorescence test (IFT). Patients with “non-pauci-immune” AAV also presented terminal chronic renal disease (TCRD).

Conclusion

There is an association between low complement and the degree of renal damage in patients with AAV. Patients with renal biopsies confirming IC and/or complement deposits showed more aggressive renal disease.

Key Points
• The complement system has an important role in the pathogenesis of vasculitis associated to antineutrophilic cytoplasmic antibody.
• The studies in murine models confirming the complement activation by alternative pathway and particularly the receptor C5a (C5aR) is necessary for the development of glomerulonefritis.
• Complement deposit observed in the renal biopsies of patients diagnosed with AAV was correlated to greater kidney damage, greater proteinuria and major disease activity compared to patients diagnosed with typical pauci-immune vasculitis.
• The presence of hypocomplementemia at the onset of the disease was also associated with a greater organ involvement, poor prognosis and greater mortality.

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Acknowledgments

We would like to thank Jovanka Vukovic for helping us translate this manuscript.

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Correspondence to L. García.

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The present study was approved by the Ethics Committee following recommendations of the Declaration of Helsinki. Being it a retrospective study, the informed consent was not considered necessary granting data confidentiality.

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García, L., Pena, C.E., Maldonado, R.Á. et al. Increased renal damage in hypocomplementemic patients with ANCA-associated vasculitis: retrospective cohort study. Clin Rheumatol 38, 2819–2824 (2019). https://doi.org/10.1007/s10067-019-04636-9

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Keywords

  • ANCA vasculitis
  • Complement
  • Kidney involvement
  • Prognosis