Glomerular Immune Deposition in MPO-ANCA Associated Glomerulonephritis Is Associated With Poor Renal Survival

Autor: Zhou Xiao, Hui Luo, Jinbiao Chen, Xiang Ao, Yong Zhong, Ting Meng, Wei Lin, Joshua D. Ooi, Jing Huang, Chanjuan Shen, Ya Ou Zhou, Rong Tang, Hongling Yin, Peter J. Eggenhuizen, Ting Wu, Ping Xiao, Weisheng Peng, Qiaoling Zhou, Xiangcheng Xiao
Rok vydání: 2020
Předmět:
0301 basic medicine
Male
pauci-immune
Time Factors
MPO – myeloperoxidase
Biopsy
Kidney Glomerulus
030232 urology & nephrology
Fluorescent Antibody Technique
Gastroenterology
chemistry.chemical_compound
0302 clinical medicine
Glomerulonephritis
Risk Factors
Rapidly progressive glomerulonephritis
Immunology and Allergy
Original Research
Kidney
medicine.diagnostic_test
ANCA
AAV (ANCA-associated vasculitis)
Middle Aged
Immune complex
Immunoglobulin Isotypes
medicine.anatomical_structure
Treatment Outcome
Disease Progression
Drug Therapy
Combination
Female
Renal biopsy
medicine.symptom
Immunosuppressive Agents
lcsh:Immunologic diseases. Allergy
Adult
medicine.medical_specialty
Immunology
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
immune deposits
Risk Assessment
Antibodies
Antineutrophil Cytoplasmic
03 medical and health sciences
Internal medicine
medicine
Humans
Cyclophosphamide
Glucocorticoids
Anti-neutrophil cytoplasmic antibody
Aged
Peroxidase
Retrospective Studies
Creatinine
business.industry
Complement System Proteins
medicine.disease
030104 developmental biology
chemistry
Pauci-immune
Kidney Failure
Chronic
lcsh:RC581-607
business
Zdroj: Frontiers in Immunology
Frontiers in Immunology, Vol 12 (2021)
ISSN: 1664-3224
Popis: BackgroundRapidly progressive glomerulonephritis caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is typically characterized as pauci-immune glomerulonephritis. However, immune complex (IC) deposition in the glomerulus has been reported in a growing number of studies. Here, we assess the presence of glomerular immune deposits alongside renal outcome in myeloperoxidase (MPO)-ANCA associated glomerulonephritis (MPO-ANCA GN).MethodsClinical and histopathologic characteristics of 97 patients with MPO-ANCA GN classified by renal biopsy from January 2008 to December 2019 were extracted retrospectively from electronic medical records. The extent of immune deposits in the kidney (C3, C4, C1q, IgA, IgG, IgM) at diagnosis were analyzed by immunofluorescence (IF). Patients were followed up for a median period of 15 months. The response to treatment and outcomes of renal and histological lesion changes were also assessed.ResultsIn our study, 41% (40/97) of patients showed positive IF (≥2+) for at least one of the six immunoglobulin or complement components tested. Patients with IC deposits showed higher levels of serum creatinine (p=0.025), lower platelet counts (p=0.009), lower serum complement C3 (sC3) (≤790 ml/L) (p=0.013) and serum IgG (p=0.018) than patients with pauci-immune (PI) deposition at diagnosis. End-stage renal disease was negatively associated with eGFR (HR 0.885, 95% CI 0.837 to 0.935, pConclusionIn conclusion, patients with immune complex deposits in the kidney showed less platelet count, lower sC3 and sIgG levels, and higher serum creatinine levels. Patients with low sC3 at initial and with continued low sC3 during the treatment displayed a trend toward poorer kidney survival. Moreover, the IC group showed a worse renal outcome than the PI group, further enforcing the present strategy of introducing complement targeted therapies in AAV.
Databáze: OpenAIRE
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