Clinicopathological Characteristics and Outcomes of Chinese Patients with Scanty Immune Deposits Lupus Nephritis: A Large Cohort Study from a Single Center

Li, Qiuyu; Song, Di; Wang, Fengmei; Tan, Ying; Feng, Yu; Zhao, Ming‐Hui

doi:10.1155/2014/212597

Cited by 5 publications

(3 citation statements)

References 41 publications

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“…In this study, we found that compared with negative ANCA serology, positive ANCA serology at the time of biopsy appeared to be associated with serologically more active lupus (higher dsDNA titers and lower serum Hb concentrations) and worse baseline renal function, a finding that has also been reported by others [19]. This study suggests that we should pay more attention to these patients and strengthen management to help patients understand the characteristics of this disease and cooperate with treatments.…”

Section: Discussionsupporting

confidence: 81%

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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 81%

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

et al. 2020

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“…Systemic lupus erythematosus (SLE) is a chronic progressive autoimmune disease involving systemic multisystem and is often accompanied by renal lesions, called lupus nephritis (LN) with higher morbidity and mortality. [ 1 ] A study showed that kidney damage occurs in up to 60% of patients with lupus. In addition, approximately 10% to 15% of patients with LN progress to end-stage renal disease and require blood dialysis to sustain life, whereas the 5-year survival rate is approximately 82%.…”

Section: Introductionmentioning

confidence: 99%

Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis

et al. 2017

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Objective:This study systemically evaluated the efficacy and safety of intermittent intravenous pulse therapy with different doses of cyclophosphamide (CTX) for the treatment of lupus nephritis (LN).Methods:We screened the Chinese Journal Full-text Database (CNKI, 1994–present), China Biology Medicine (CBMdisc, 1978–present), VIP Database for Chinese Technical Periodicals (1989–present), PubMed (1948–present), MEDLINE (Ovid SP, 1946–present), Embase (1947–present), and the Cochrane controlled trials register (13, 2017). Literature reports were selected according to the inclusion and exclusion criteria, effective data were extracted, research quality was evaluated, and RevMan5.2 was used for meta-analysis.Results:Seven randomized controlled studies were included, consisting of 655 patients. The meta-analysis results showed no significant differences between the low- and high-dose cyclophosphamide groups in partial, complete, and total remission rates as well Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). Furthermore, there were no significant differences between the 2 groups in hematologic toxicity and gastrointestinal reaction, but the risk of infection (risk ratio [RR] = 0.74, 95% confidence interval [CI], 0.56–0.98, total effect inspection Z = 2.12, P = .03), and menstrual disorder (RR = 0.46, 95% CI, 0.31–0.69, total effect inspection Z = 3.83, P = .0001) decreased in the low-dose cyclophosphamide group.Conclusions:There was no obvious difference between the low- and high-dose cyclophosphamide groups in efficacy in the treatment of lupus nephritis, but the risk of infection and menstrual disorder significantly decreased in the low-dose group.

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“… 6 , 7 , 8 A small number of case series in the literature have looked at ANCA serology in patients with focal and segmental LN characterized by necrosis without prominent subendothelial immune deposits. Some report an association between this histopathologic phenotype and ANCA positivity, 9 , 10 but others found no association. 11 , 12 None of these studies systematically studied ANCA serology in their cohorts of patients with LN.…”

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confidence: 99%

Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy

Turner‐Stokes

Wilson

Morreale

et al. 2017

Kidney International

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Class IV-S lupus nephritis is often associated with more necrosis and fewer subendothelial immune deposits compared to class IV-G lupus nephritis, suggestive of necrotising glomerular inflammation found in antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis. ANCAs are present in a significant proportion of patients with lupus nephritis. Here we determine whether ANCAs are associated with distinct clinical and histopathologic features of lupus nephritis. Thirty-two ANCA-positive biopsies were compared to 222 ANCA-negative biopsies from patients with lupus nephritis. The majority (82%) of ANCA-positive patients had antimyeloperoxidase antibodies. Class IV-S lupus nephritis and glomerular necrosis were significantly more common (36% vs. 16% and 35% vs. 15%, respectively) and isolated Class V lupus nephritis significantly less common (10% vs. 29%) in the ANCA-positive group. ANCA-positive patients had significantly higher dsDNA titers (335u/ml vs. 52u/ml), significantly lower serum C4 concentrations (0.125g/L vs. 0.15g/L) and significantly higher serum creatinine (130μmol/L vs. 84μmol/L) at the time of biopsy. Hence ANCAs appear to influence the histological pattern of lupus nephritis and are associated with worse baseline renal function and more active lupus serology. There was no significant difference in outcome between groups when matched for severity of disease and treatment using propensity scoring. Thus, further studies are needed to examine whether ANCAs in patients with lupus nephritis have a pathogenic role and whether they are associated with worse renal outcomes or are simply a marker of more severe disease.

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Clinicopathological Characteristics and Outcomes of Chinese Patients with Scanty Immune Deposits Lupus Nephritis: A Large Cohort Study from a Single Center

Cited by 5 publications

References 41 publications

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

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

Systematic evaluation of different doses of cyclophosphamide induction therapy for lupus nephritis

Positive antineutrophil cytoplasmic antibody serology in patients with lupus nephritis is associated with distinct histopathologic features on renal biopsy

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