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Clinical and pathological analysis of 101 cases of ANCA-associated vasculitic kidney injury

  • Nephrology - Original Paper
  • Published:
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Abstract

Objective

To analyze the clinical and pathological features of patients with anti-neutrophilic cytoplasmic antibody (ANCA)-associated vasculitic (AASV)-kidney injury (AASVKI).

Methods

From January 2015 to December 2018, a total of 101 AASVKI patients treated in the First Hospital of Jilin University were divided into 2 groups (the pANCA-positive group and the cANCA-positive group) for comparison; 63 patients were performed renal biopsy and divided into 3 groups according to pathological results [the non-crescent nephritis group (non-C), the crescent nephritis group (C), and the sclerotic nephritis group (S)] for comparison.

Results

Compared with the Group pANCA, Group cANCA exhibited higher incidence of eye involvement (P = 0.039) and skin mucosa destruction (P = 0.045), higher serum creatinine (Scr) (P < 0.001), higher 24-h urine protein quantification (P = 0.045), but lower hemoglobin (Hb) (P < 0.001). Compared with Group non-C, Group C had higher Scr (P < 0.001) and urinary red blood cells (P = 0.010), lower estimated glomerular filtration rate (eGFR) (P = 0.003), hemoglobin (HD)-dependence (P = 0.042), and higher mortality rate within 1 year (P = 0.005); compared with Group S, Group C had faster onset of erythrocyte sedimentation rate (ESR) (P = 0.031), higher urinary red blood cells (P = 0.029), and lower incidence of HD-dependence (P = 0.038).

Conclusions

AASVKI patients with positive cANCA have poor renal function, among whom the patients with crescent type have poorer renal function than those with non-crescent type, have higher urinary red blood cells while lower HD-dependence than those with sclerotic type.

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References

  1. Daves DJ, Moran JE, Niall JF, Ryan GB (1982) Segmental necrotising glomerulonephritis with antineutrophil antibody: possible arbovirus aetiology? Br Med J (Clin Res Ed) 285:606. https://doi.org/10.1136/bmj.285.6342.606

    Article  Google Scholar 

  2. Bosch X, Guilabert A, Font J (2006) Antineutrophil cytoplasmic antibodies. Lancet 368:404–418. https://doi.org/10.1016/S0140-6736(06)69114-9

    Article  CAS  PubMed  Google Scholar 

  3. Watts RA, Mooney J, Skinner J, Scott DG, Macgregor AJ (2012) The contrasting epidemiology of granulomatosis with polyangiitis (Wegener’s) and microscopic polyangiitis. Rheumatology (Oxford) 51:926–931. https://doi.org/10.1093/rheumatology/ker454

    Article  Google Scholar 

  4. Jayne D (2017) Vasculitis—when can biopsy be avoided? Nephrol Dial Transpl 32:1454–1456. https://doi.org/10.1093/ndt/gfx248

    Article  Google Scholar 

  5. Berden AE, Wester Trejo MAC, Bajema IM (2018) Investigations in systemic vasculitis—the role of renal pathology. Best Pract Res Clin Rheumatol 32:83–93. https://doi.org/10.1016/j.berh.2018.10.010

    Article  PubMed  Google Scholar 

  6. Lally L, Spiera R (2015) Current therapies for ANCA-associated vasculitis. Annu Rev Med 66:227–240. https://doi.org/10.1146/annurev-med-011514-023051

    Article  CAS  PubMed  Google Scholar 

  7. Bossuyt X, Cohen Tervaert JW, Arimura Y, Blockmans D, Flores-Suárez LF, Guillevin L, Hellmich B, Jayne D, Jennette JC, Kallenberg CGM, Moiseev S, Novikov P, Radice A, Savige JA, Sinico RA, Specks U, van Paassen P, Zhao MH, Rasmussen N, Damoiseaux J, Csernok E (2017) Position paper: revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis. Nat Rev Rheumatol 13:683–692. https://doi.org/10.1038/nrrheum.2017.140

    Article  PubMed  Google Scholar 

  8. Bomback AS, Appel GB, Radhakrishnan J, Shirazian S, Herlitz LC, Stokes B, D’Agati VD, Markowitz GS (2011) ANCA-associated glomerulonephritis in the very elderly. Kidney Int 79:757–764. https://doi.org/10.1038/ki.2010.489

    Article  PubMed  Google Scholar 

  9. Haris Á, Polner K, Arányi J, Braunitzer H, Kaszás I, Mucsi I (2014) Clinical outcomes of ANCA-associated vasculitis in elderly patients. Int Urol Nephrol 46:1595–1600. https://doi.org/10.1007/s11255-014-0717-y

    Article  CAS  PubMed  Google Scholar 

  10. Haas M, Verhave JC, Liu ZH, Alpers CE, Barratt J, Becker JU, Cattran D, Cook HT, Coppo R, Feehally J, Pani A, Perkowska-Ptasinska A, Roberts IS, Soares MF, Trimarchi H, Wang S, Yuzawa Y, Zhang H, Troyanov S, Katafuchi R (2017) A multicenter study of the predictive value of crescents in IgA nephropathy. J Am Soc Nephrol 28:691–701. https://doi.org/10.1681/ASN.2016040433

    Article  CAS  PubMed  Google Scholar 

  11. Lionaki S, Blyth ER, Hogan SL, Hu Y, Senior BA, Jennette CE, Nachman PH, Jennette JC, Falk RJ (2012) Classification of antineutrophil cytoplasmic autoantibody vasculitides: the role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis. Arthritis Rheum 64:3452–3462. https://doi.org/10.1002/art.34562

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Asada N, Takase M, Nakamura J, Oguchi A, Asada M, Suzuki N, Yamamura K, Nagoshi N, Shibata S, Rao TN, Fehling HJ, Fukatsu A, Minegishi N, Kita T, Kimura T, Okano H, Yamamoto M, Yanagita M (2011) Dysfunction of fibroblasts of extrarenal origin underlies renal fibrosis and renal anemia in mice. J Clin Invest 121:3981–4390. https://doi.org/10.1172/JCI57301

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kawamura T, Usui J, Kaneko S, Tsunoda R, Imai E, Kai H, Morito N, Saito C, Nagata M, Yamagata K (2017) Anaemia is an essential complication of ANCA-associated renal vasculitis: a single center cohort study. BMC Nephrol 18:337. https://doi.org/10.1186/s12882-017-0754-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Wang Y, Wei RB, Su TY, Huang MJ, Li P, Chen XM (2019) Clinical and pathological factors of renal anaemia in patients with IgA nephropathy in Chinese adults: a cross-sectional study. BMJ Open 9:e023479. https://doi.org/10.1136/bmjopen-2018-023479

    Article  PubMed  PubMed Central  Google Scholar 

  15. Chen T, Xu PC, Hu SY, Gao S, Jia JY, Yan TK (2019) High serum hepcidin is associated with the occurrence of anemia in anti-myeloperoxidase antibody-associated vasculitis with normal kidney function: a cross-sectional study. Rheumatol Int 39:851–857. https://doi.org/10.1007/s00296-019-04292-x

    Article  CAS  PubMed  Google Scholar 

  16. Jennette JC, Falk RJ, Hu P, Xiao H (2013) Pathogenesis of antineutrophil cytoplasmic autoantibody-associated small-vessel vasculitis. Annu Rev Pathol 8:139–160. https://doi.org/10.1146/annurev-pathol-011811-132453

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Shuai ZW, Lv YF, Zhang MM, Hu ZY (2015) Clinical analysis of patients with myeloperoxidase antineutrophil cytoplasmic antibody-associated vasculitis. Genet Mol Res 14:5296–5303. https://doi.org/10.4238/2015.May.18.22

    Article  CAS  PubMed  Google Scholar 

  18. Flossmann O, Berden A, de Groot K, Hagen C, Harper L, Heijl C, Höglund P, Jayne D, Luqmani R, Mahr A, Mukhtyar C, Pusey C, Rasmussen N, Stegeman C, Walsh M, Westman K, European Vasculitis Study Group (2011) Long-term patient survival in ANCA-associated vasculitis. Ann Rheum Dis 70:488–494. https://doi.org/10.1136/ard.2010.137778

    Article  PubMed  Google Scholar 

  19. Wallace ZS, Miloslavsky EM (2020) Management of ANCA associated vasculitis. BMJ 368:m421. https://doi.org/10.1136/bmj.m421

    Article  PubMed  Google Scholar 

  20. Miyanaga M, Takase H, Ohno-Matsui K (2020) Anti-neutrophil cytoplasmic antibody-associated ocular manifestations in Japan: a review of 18 patients. Ocul Immunol Inflamm 20:1–6. https://doi.org/10.1080/09273948.2020.1712432

    Article  CAS  Google Scholar 

  21. Chen M, Xing GQ, Yu F, Liu G, Zhao MH (2009) Complement deposition in renal histopathology of patients with ANCA-associated pauci-immune glomerulonephritis. Nephrol Dial Transpl 24:1247–1252. https://doi.org/10.1093/ndt/gfn586

    Article  CAS  Google Scholar 

  22. Berden AE, Ferrario F, Hagen EC, Jayne DR, Jennette JC, Joh K, Neumann I, Noël LH, Pusey CD, Waldherr R, Bruijn JA, Bajema IM (2010) Histopathologic classification of ANCA-associated glomerulonephritis. J Am Soc Nephrol 21:1628–1636. https://doi.org/10.1681/ASN.2010050477

    Article  PubMed  Google Scholar 

  23. Prakash J, Patel PS, Prakash S, Iqbal M, Sharma SS, Singh S, Singh U (2019) Etiopathological study of crescentic glomerulonephritis and its outcome: a retrospective analysis. J Assoc Physicians India 67:18–21

    PubMed  Google Scholar 

  24. Andrassy K, Erb A, Koderisch J, Waldherr R, Ritz E (1991) Wegener’s granulomatosis with renal involvement: patient survival and correlations between initial renal function, renal histology, therapy and renal outcome. Clin Nephrol 35:139–147

    CAS  PubMed  Google Scholar 

  25. Chen YX, Xu J, Pan XX, Shen PY, Li X, Ren H, Chen XN, Ni LY, Zhang W, Chen N (2017) Histopathological classification and renal outcome in patients with antineutrophil cytoplasmic antibodies-associated renal vasculitis: a study of 186 patients and metaanalysis. J Rheumatol 44:304–313. https://doi.org/10.3899/jrheum.160866

    Article  PubMed  Google Scholar 

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Author notes

  1. Co-first authors: Shumiao Yang, Yafang Liu.

Authors and Affiliations

  1. Department of Nephrology, The First Hospital of Jilin University, Changchun, 130031, China

    Shumiao Yang, Qingfei Xiao, Chenhao Li & Hongyue Wang

  2. Department of Pathology, The First Hospital of Jilin University, Changchun, 130031, China

    Yafang Liu

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Correspondence to Hongyue Wang.

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Yang, S., Liu, Y., Xiao, Q. et al. Clinical and pathological analysis of 101 cases of ANCA-associated vasculitic kidney injury. Int Urol Nephrol 53, 2099–2106 (2021). https://doi.org/10.1007/s11255-021-02793-y

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  • DOI: https://doi.org/10.1007/s11255-021-02793-y

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