Estimating Renal Survival Using the ANCA-Associated GN Classification

Hilhorst, Marc; Wilde, Benjamin; Vriesman, P. van Breda; Paassen, Pieter van; Tervaert, Jan Willem Cohen

doi:10.1681/asn.2012090912

Cited by 97 publications

(74 citation statements)

References 12 publications

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“…29 However, the presence of hematuria in combination with red cell casts, dysmorphic erythrocytes (.10), and/or proteinuria sufficed (a renal biopsy was not performed in 12 patients with renal involvement). 30 Disease activity was scored using the Birmingham Vasculitis Activity Score (version 3).…”

Section: Concise Methodsmentioning

confidence: 99%

“…31 Patients were treated according to the European League Against Rheumatism guidelines as previously described. 29 Maintenance therapy was given for at least 18 months and tapered within 24 months according to protocol in newly diagnosed patients. 32 Patients who previously relapsed and/or relapsed during our study while using maintenance therapy were offered long-term maintenance therapy.…”

Section: Concise Methodsmentioning

confidence: 99%

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ANCA as a Predictor of Relapse

Kemna

Damoiseaux

Austen

et al. 2015

Journal of the American Society of Nephrology

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191

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The value of measuring ANCA during follow-up to predict a relapse is controversial. On the basis of recently obtained pathophysiologic insights, we postulated that measuring ANCA is useful in patients with renal involvement but is less valuable in patients with nonrenal disease. One hundred sixty-six consecutive patients with ANCA-associated vasculitis, positive for either proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA, were included in our study, followed at regular intervals, and tested for PR3-ANCA and MPO-ANCA. In this cohort, 104 patients had renal involvement (72 with PR3-ANCA, 32 with MPO-ANCA) and 62 patients had nonrenal disease (36 with PR3-ANCA, 26 with MPO-ANCA). During an average (6SD) follow-up of 49633 months and 18614 ANCA measurements, 89 ANCA rises and 74 relapses were recorded. ANCA rises correlated with relapses in patients who presented with renal involvement (hazard ratio [HR], 11.09; 95% confidence interval [95% CI], 5.01 to 24.55), but in comparison, associated only weakly with relapses in patients who presented with nonrenal disease (HR, 2.79; 95% CI, 1.30 to 5.98). In conclusion, longitudinal ANCA measurements may be useful in patients with renal involvement but is less valuable in patients with nonrenal disease.

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Section: Concise Methodsmentioning

confidence: 99%

Section: Concise Methodsmentioning

confidence: 99%

ANCA as a Predictor of Relapse

Kemna

Damoiseaux

Austen

et al. 2015

Journal of the American Society of Nephrology

Self Cite

191

180

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“…Renal involvement was determined by a renal biopsy showing pauci-immune necrotizing glomerulonephritis [23]. Disease activity was scored using the Birmingham Vasculitis Activity Score (BVAS) version 3 [24].…”

Section: Classification Of Patientsmentioning

confidence: 99%

“…Disease activity was scored using the Birmingham Vasculitis Activity Score (BVAS) version 3 [24]. Patients were treated according to the European League against Rheumatism (EULAR) guidelines, as described previously [22,23]. Remission was defined as absence of disease activity attributable to active disease during maintenance immunosuppressive therapy of a prednisone dosage of 7Á5 mg or lower [25].…”

Section: Classification Of Patientsmentioning

confidence: 99%

The avidity of PR3-ANCA in patients with granulomatosis with polyangiitis during follow-up

Kemna

Schlumberger

Paassen

et al. 2016

Clinical and Experimental Immunology

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SummaryThe objective of this study is to investigate whether the avidity of proteinase-3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) changes during follow-up in different subgroups of patients with granulomatosis with polyangiitis (GPA). We selected 10 patients with renal relapsing GPA, 10 patients with renal non-relapsing GPA and 10 patients with non-renal relapsing GPA. In all patients, an ANCA rise occurred during remission. The avidity was measured using a chaotropic approach at the time of an ANCA rise and at the time of a relapse in relapsing patients or timematched during remission in non-relapsing patients. No difference was observed in the avidity at the ANCA rise between renal relapsing patients [26Á2% (15Á5-47Á5)], renal patients without a relapse [39Á6% (21Á2-63Á4)] and non-renal relapsing patients [34Á2% (21Á6-59Á5)]. In renal relapsing patients, the avidity increased significantly from the moment of the ANCA rise to the relapse [difference 6Á4% (0Á0-17Á1), P 5 0Á0273]. The avidity did not increase after an ANCA rise in renal non-relapsing patients [difference 3Á5 (26Á0 to 10Á1), P 5 0Á6250] or in non-renal relapsing patients [difference 23Á1% (28Á0 to 5Á0), P 5 0Á5703]. The avidity of PR3-ANCA increases after an ANCA rise during follow-up in renal relapsing patients, but not after an ANCA rise in renal patients who remain in remission or in non-renal relapsing patients.

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“…The presence of impaired renal function, and the low percentage of normal glomeruli (<25%) in our population are factors known to be associated with poor renal outcome [25,34,35].…”

Section: Discussionmentioning

confidence: 86%

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in Mexican Population: Clinical Phenotype, Autoantibody Profile and Renal Characteristics

Hinojosa‐Azaola¹,

Núñez‐Álvarez²,

Uriarte-Hernández³

et al. 2016

J Vasc

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Objective: To describe the clinical, serological characteristics, and renal histology in Mexican patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Methods:Forty patients with diagnosis of AAV and renal biopsy, followed at a tertiary care center in Mexico City from 2002-2012 were retrospectively studied. Demographics, comorbidities, clinical, laboratory variables, disease activity, mortality, renal variables and histological classes were analyzed. Additionally, 50 patients with AAV, and a control group (other systemic vasculitis, systemic lupus erythematosus, infections, healthy subjects) were studied transversally to assess the prevalence of specific antibodies (ANCA, MPO, PR3, cathepsin G, lysozyme, lactoferrin, BPI and elastase), and their association with clinical manifestations.Results: Granulomatosis with polyangiitis (GPA) was the predominant phenotype, and median age at diagnosis was 53 years. High disease activity (BVAS/GPA=24), general symptoms (98%), renal (80%), pulmonary (63%), and ear, nose and throat (ENT) (58%) involvement were frequent at diagnosis. Renal damage was present at diagnosis (serum creatinine 3.9 mg/dl, estimated glomerular filtration rate 16 ml/min, 24 hr proteinuria 2.5 g, 15% on dialysis). The most prevalent renal histological class was sclerotic (58%), followed by mixed (32%), focal (8%), and crescentic (2%). No significant differences were found between histological classes in comorbidities, clinical, renal and laboratory variables, or survival. The main ANCA immunofluorescence pattern was C-ANCA (68%), followed by X-ANCA (22%), and P-ANCA (18%). PR3-ANCA (high sensitive) was the most frequent antibody, positive in 86%, while positivity for MPO-ANCA was observed in 18%. ANCA positivity was more frequent in patients with AAV than the control group (p<0.001). Antibodies directed to minor targets were infrequent in patients with AAV (2%). No significant correlations were identified between autoantibodies and clinical manifestations. Conclusion:GPA phenotype, C-ANCA and PR3-ANCA positivity, high disease activity, chronic renal damage, general symptoms, ENT and lung involvement at diagnosis distinguish our population with AAV.

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Estimating Renal Survival Using the ANCA-Associated GN Classification

Cited by 97 publications

References 12 publications

ANCA as a Predictor of Relapse

ANCA as a Predictor of Relapse

The avidity of PR3-ANCA in patients with granulomatosis with polyangiitis during follow-up

Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis in Mexican Population: Clinical Phenotype, Autoantibody Profile and Renal Characteristics

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