Clinicopathologic characteristics and outcomes of lupus nephritis with positive antineutrophil cytoplasmic antibody

Abstract

Aims: The aim was to determine whether anti-neutrophil cytoplasmic antibody (ANCA)-positive serology in patients with lupus nephritis (LN) is associated with different clinicopathologic features and outcomes. Methods: In our retrospective analysis, 283 patients were enrolled between 2013 and 2018. Thirty-six patients were ANCA-positive, and this group was compared with the remaining 247 patients who were confirmed as ANCA-negative at the time of biopsy. Results: ANCA-positive LN patients exhibited higher anti-dsDNA antibody titers and serum creatinine levels and lower serum hemoglobin concentrations than ANCA-negative LN patients. On pathological evaluation, segmental endocapillary hypercellularity observed by light microscopy was significantly more common in the ANCA-positive group. This feature was not significantly different in the treatment group, but the response to treatment was significantly different, as was remission (76.1% vs 69.4%, p < 0.001), between the ANCA-negative and ANCA-positive groups. During follow-up, the times to renal replacement therapy (RRT) and death were significantly different between the two unmatched groups (chi-square test, p ¼ 0.041). Multivariate Cox analysis revealed that neurological disorders, ANCA positivity, and the chronicity index (CI) remained independent risk factors for patient survival. Pulmonary infection was the main cause of death and was most often due to fungal infection. Conclusion: ANCA-positive LN patients typically exhibited higher anti-dsDNA antibody titers, lower serum hemoglobin concentrations and worse renal function than ANCA-negative LN patients. Fungal infection was the main cause of death. We observed that ANCA positivity was an independent risk factor for patient survival.

Current Insights on Biomarkers in Lupus Nephritis: A Systematic Review of the Literature

“…Some of the ANCAs have been shown to be strongly associated with so-called “pauci-immune” glomerulonephritides due to the absence of deposits of immune complexes within the glomerular tuft [ 151 , 152 ]. In two retrospective studies of Chinese patients with LN, Wang et al explored the clinical relevance of ANCAs in LN [ 153 , 154 ]. In these works, anti-myeloperoxidase (MPO) ANCA was demonstrated to be the most prevalent ANCA in ANCA-positive LN patients.…”

“…In these works, anti-myeloperoxidase (MPO) ANCA was demonstrated to be the most prevalent ANCA in ANCA-positive LN patients. An increased risk of mortality in ANCA-positive LN patients compared with ANCA-negative LN patients was observed both in the first (HR adj = 3.4; p = 0.03 [ 153 ]) and the second study (RR adj = 3.6; p = 0.016 [ 154 ]).…”

Clinicopathologic features in childhood-onset lupus nephritis with antineutrophil cytoplasmic antibody positivity——a multi-center retrospective study

“…Pauci-immune glomerulonephritis was not reported in another pediatric cohort or adult cohorts of LN with ANCA positivity either. 6,12,21 These inconsistent results emphasized the need of further prospective studies to clarify the relationship between ANCAs and the degree of renal immune deposition in context of LN.…”

Involvement of neutrophil extracellular traps in the pathogenesis of glomerulonephritis in a case of systemic lupus erythematosus and antineutrophil cytoplasmic antibody-associated vasculitis overlap syndrome

“…In some cases, the symptoms of both diseases may present at different times. On the other hand, it has already been reported that 16–42% of SLE cases and 37–53% of LN cases are ANCA positive [ 10 ]. LN patients with ANCA positivity tend to have a higher clinical severity than those without ANCA.…”