Anti-neutrophil cytoplasmic antibody in patients with systemic lupus erythematosus is unrelated to clinical features

Nishiya, Koji; Chikazawa, Hiroaki; Nishimura, Shuji; Hisakawa, Naoko; Hashimoto, Kozo

doi:10.1007/bf02238766

Cited by 43 publications

(35 citation statements)

References 17 publications

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“…ANCA seropositivity was associated with the presence of nephritis, particularly LN IV, as well as anti-dsDNA antibodies (17). Other reports have failed to show a correlation between ANCA and clinical features or organ involvement (14,18,19).…”

Section: Discussionmentioning

confidence: 91%

Necrotizing and Crescentic Lupus Nephritis with Antineutrophil Cytoplasmic Antibody Seropositivity

Nasr

D’Agati

Park

et al. 2008

Clinical Journal of the American Society of Nephrology

124

115

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Background and objectives: Lupus nephritis is a classic immune complex glomerulonephritis. In contrast, antineutrophil cytoplasmic antibodies are associated with necrotizing and crescentic glomerulonephritis, in the absence of significant immune deposits. Antineutrophil cytoplasmic antibodies are detected by indirect immunofluorescence in 20% of patients with systemic lupus erythematosus. We report 10 cases of necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity.Design, setting, participants, & measurements: Ten patients with systemic lupus erythematosus, antineutrophil cytoplasmic antibody positivity, and renal biopsy findings of lupus nephritis and antineutrophil cytoplasmic antibody-associated glomerulonephritis were identified. The clinical features, pathologic findings, and outcomes are described.Results: The cohort consisted of eight women and two men with a mean age of 48.4 yr. Perinuclear antineutrophil cytoplasmic antibody was detected by indirect immunofluorescence in nine patients. Four of the nine patients and the single remaining patient were found to have myeloperoxidase-antineutrophil cytoplasmic antibodies by enzyme-linked immunosorbent assay. Clinical presentation included proteinuria, hematuria, and acute renal insufficiency, with mean creatinine of 7.1 mg/dl. All biopsies exhibited prominent necrosis and crescents with absent or rare subendothelial deposits and were interpreted as lupus nephritis and antineutrophil cytoplasmic antibody-associated glomerulonephritis. All patients received cyclophosphamide and prednisone. Three patients died of infectious complications. Among the remaining seven patients, five achieved a complete or near-complete remission, one had a remission with subsequent relapse, and one had no response to therapy.Conclusion: Antineutrophil cytoplasmic antibody-associated necrotizing and crescentic glomerulonephritis may occur superimposed on lupus nephritis. In patients with lupus nephritis and biopsy findings of prominent necrosis and crescent formation in the absence of significant endocapillary proliferation or subendothelial deposits, antineutrophil cytoplasmic antibody testing by enzyme-linked immunosorbent assay is recommended.

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Section: Discussionmentioning

confidence: 91%

Necrotizing and Crescentic Lupus Nephritis with Antineutrophil Cytoplasmic Antibody Seropositivity

Nasr

D’Agati

Park

et al. 2008

Clinical Journal of the American Society of Nephrology

124

115

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“…A negative correlation has been reported between the presence of ANCA and nephritis [15,16], specific renal pathologic findings, renal prognosis, mortality [4,17], and vasculitis [15]. On the other hand, Ecklund et al [7] found a relation to the presence of nephritis.…”

Section: Discussionmentioning

confidence: 97%

“…Many studies have demonstrated no correlation between ANCA and the activity of SLE [2,14,15]. On the other hand, its association with relapse [16] or disease activity has also been reported [4].…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have focused on the renal manifestations of SLE in regard to ANCA. Some authors reported that both clinical courses and pathologic findings [4] in LN are not associated with ANCA or its subspecificities [5,6]. On the other hand, others showed associations between the presence of anti-LF antibody and nephritis [7], severe LN [3], and crescent formation [8].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Implications of Antineutrophil Cytoplasmic Antibody Test in Lupus Nephritis

et al. 2000

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To elucidate the prevalence and clinical implications of antineutrophil cytoplasmic antibody (ANCA) in lupus nephritis (LN), we examined ANCA by indirect immunofluorescence and by ELISA against antilactoferrin (anti-LF) and antimyeloperoxidase (anti-MPO) antibody. To discriminate perinuclear ANCA (pANCA) with antinuclear antibody (ANA), all the ANCA-positive sera were tested again after incubating patients’ sera with single-stranded (SS) and double-stranded (ds) DNA. These results were compared with clinicopathologic manifestations and clinical courses of LN. ANCA was positive in 19 (37.3%) of 51 LN patients. Among these LN patients, 3 had cytoplasmic ANCA (cANCA) and 16 had pANCA. ANCA was not found in 8 SLE patients without nephritis and 30 normal controls. The presence of ANCA, particularly pANCA, was associated with the presence of nephritis (18/51 cases vs. 0/8 cases, p < 0.05), especially with diffuse proliferative lupus nephritis, WHO class IV (17/18 cases vs. 21/31 cases, p < 0.05) as well as the presence of anti-dsDNA antibody (17/19 cases vs. 18/30 cases, p < 0.05). Patients with ANCA frequently had deterioration of renal function (3/16 vs. 0/26 cases). Anti-LF antibody was positive in 13 patients. Among those, 12 patients had nephritis. Five patients with anti-LF antibody did not have ANCA, but 7 had pANCA, and 1 had cANCA. Patients with anti-LF antibody had lower initial creatinine levels than those without it [serum creatinine (mg/dl): 0.78 (0.6–1.0) vs. 1.43 (0.5–5.0), p < 0.05]. Anti-MPO antibody was positive in only 1 patient, suggesting that MPO is a rare antigen for ANCA in LN.

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“…ANCA directed against various neutrophil cytoplasmic constituents have been demonstrated by antigen-speci®c assays, but the antigens responsible for ANCA reactivity in SLE have still not been fully determined and the role of ANCA in SLE remains unclear. Moreover, reports are controversial concerning their clinical relevance [10,11,12,13,14,15,16].…”

Section: Introductionmentioning

confidence: 99%

Antineutrophil cytoplasmic antibodies in patients with systemic lupus erythematosus: prevalence, antigen specificity, and clinical associations

Manolova

Dancheva

Halacheva

2001

Rheumatology International

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Fifty-five patients with systemic lupus erythematosus (SLE) were examined for antineutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence (IIF). Enzyme-linked immunosorbent assay (ELISA) for ANCA against myeloperoxidase (MPO), lactoferrin (LF), proteinase 3 (PR3), elastase (HLE), and bactericidal/permeability-increasing protein (BPI) was performed. The prevalence of ANCA by IIF was 29.1% (16/55 patients). MPO-ANCA were found in 10.9% (6/55), LF-ANCA in 18.2% (10/55), PR3-ANCA in 12.7% (7/55), BPI-ANCA in 23.6% (13/55), and HLE-ANCA in 1.8% (1/55). The levels of BPI-, LF-, and PR3-ANCA correlated with disease activity. A significant association between serositis and the presence of BPI-, LF-, and PR3-ANCA was observed, and PR3-ANCA were found to be associated with arthritis as well. Our results demonstrate that ANCA of various specificities occur in SLE, and BPI appears to be an important target antigen.

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Anti-neutrophil cytoplasmic antibody in patients with systemic lupus erythematosus is unrelated to clinical features

Cited by 43 publications

References 17 publications

Necrotizing and Crescentic Lupus Nephritis with Antineutrophil Cytoplasmic Antibody Seropositivity

Necrotizing and Crescentic Lupus Nephritis with Antineutrophil Cytoplasmic Antibody Seropositivity

Clinical Implications of Antineutrophil Cytoplasmic Antibody Test in Lupus Nephritis

Antineutrophil cytoplasmic antibodies in patients with systemic lupus erythematosus: prevalence, antigen specificity, and clinical associations

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