Successful Management of Lupus Nephritis with High Titers of Myeloperoxidase Anti-Neutrophil Cytoplasmic Antibodies Using Tacrolimus

Abe, Yoshikazu; Shima, Tomoaki; Izumi, Yuichi; Kitamura, Mineaki; Yamashita, Hiroshi; Tsuji, Yoshika; Sasaki, Osamu; Maeda, Chie; Kawahara, Chieko; Torisu, Ai; Kawaguchi, Yuuki; Kurohama, Hirokazu; Ito, Masahiro; Iwanaga, Naoki; Kawakami, Atsushi; Nakayama, Toshiyuki; Taguchi, Takashi; Migita, Kiyoshi

doi:10.2169/internalmedicine.54.4343

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…Some studies reported that photosensitivity, oral ulcerations, and alopecia were more common in the ANCApositive group than in the ANCA-negative group [11], and others observed a higher remission rate and better prognoses when using mycophenolate mofetil (MMF) than when using cyclophosphamide as induction therapy for ANCA-positive LN patients. It was also reported that tacrolimus might be a useful immunosuppressant for patients with progressive LN and MPO-ANCAs [13,20]. The above results suggest that a preference for tacrolimus or MMF is indicated during drug selection for ANCA-positive patients.…”

Section: Discussionmentioning

confidence: 72%

“…The neutrophil-tolymphocyte ratio, ANCAs and the estimated glomerular filtration rate (EGFR) were reported to be independent risk factors for patient survival in another article [11]. Other studies also reported poor prognoses with increased ANCA values [13,18]. Among the results of the above studies, the CI is an index of renal biopsy, demonstrating the necessity of renal biopsy in LN.…”

Section: Discussionmentioning

confidence: 92%

“…The extensive necrotic and pauci-immune glomerular inflammation observed in some patients with Class IV-S LN may be associated with ANCAs [5,6,[8][9][10]. Some studies have reported an association between this histopathologic phenotype and ANCA positivity [5,6,8,9,[11][12][13], but others found no association.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 92%

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

et al. 2020

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“…It is important to note that ANCA in LN is associated with higher SLE disease activity index score [7], worse renal function [6, 7], hypocomplementemia [4–6], dsDNA Ab [2, 6], and worse renal outcome [2, 4], as was exemplified in our case. Histologically, nearly 90% of such cases have been reported in association with class III or IV LN (Table 1) [2, 4–7, 10–18]. In particular, ANCA positivity appears to be associated with higher incidence of class IV-S LN but lower incidence of class V LN, as well as endocapillary hypercellularity [6].…”

Section: Discussionmentioning

confidence: 99%

ANCA-Associated Necrotizing Glomerulonephritis Overlapping with Mesangial Proliferative Lupus Nephritis Refractory to Plasmapheresis, Steroid Pulse Therapy, and a Combination of Mycophenolate Mofetil and Rituximab

Sharmeen

Cassol

Katô

2018

Case Reports in Rheumatology

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Necrotizing glomerulonephritis (GN) associated with antineutrophil cytoplasmic antibody (ANCA) has been increasingly recognized in the context of class III or IV lupus nephritis (LN), hereafter designated as ANCA-associated necrotizing LN. While this subset of GN appears to portend an unfavorable renal outcome, it is not clear whether it represents a distinct entity and benefits from a more aggressive therapy. We report a 78-year-old woman who presented with rapidly progressive GN and was found to have a double-stranded DNA (dsDNA) antibody, hypocomplementemia, antiphospholipid antibody, and strongly positive myeloperoxidase antibody. Renal pathology showed necrotizing and crescentic GN on a background of mesangial proliferative GN. Her kidney disease did not improve despite the treatment with plasmapheresis, three doses of methylprednisolone pulse therapy followed by prednisone at 1 mg/kg/day, rituximab, and mycophenolate mofetil. This case not only reinforces the notion that ANCA-associated necrotizing LN is associated with high dsDNA antibody, hypocomplementemia, and worse renal outcome but also adds new insight into the full spectrum of this emerging disease entity by demonstrating that the concurrence of ANCA-associated vasculitis is not specific for class III or IV LN but can also be seen on a background of class II LN.

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“…Clinically, renal biopsy is often used to diagnose AAV-related renal injury and evaluate the prognosis. But high-sensitivity and high-specificity markers for early diagnosis and prognosis evaluation would be preferable due to the invasive nature of the renal biopsy procedure ( 15 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

Serum creatinine level and ESR values associated to clinical pathology types and prognosis of patients with renal injury caused by ANCA-associated vasculitis

et al. 2017

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The correlation between serum creatinine and erythrocyte sedimentation rate (ESR) values and clinical pathology and prognosis in patients with renal injury caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis were analyzed. Eighty-six patients with ANCA-associated vasculitis (AAV) treated in the Affiliated Hospital of Qingdao University were enrolled in the study. Patients were assigned into an elderly group (n=45) or a non-elderly group (n=41) according to age. The serum creatinine (Scr) level was measured via the sarcosine oxidase method, and the erythrocyte sedimentation rate (ESR) was measured using the full-automatic ESR analyzer; the relationship between Scr and ESR values and the pathology type of patients was statistically analyzed. The mean levels of Scr and ESR in the 86 patients were 406.87±12.37 µmol/l and 83.83±7.64 mm/1 h, respectively. Importantly, the levels of Scr and the ESR in the elderly group were significantly higher than those in the non-elderly group (P<0.05). In addition, patients with high levels of Scr and accelerated ESR presented mainly the crescentic and sclerotic pathological types, while in the same patients the numbers of focal and mixed types were lower (P<0.05). Kaplan-Meier analysis showed that the survival rate in the elderly group was significantly lower than that in the non-elderly group, and likewise patients with high levels of Scr and accelerated ESR had significantly lower survival rates than those with low levels of Scr and normal ESR (P<0.05). The AUC of the Scr level was 0.901, the sensitivity 90.2%, the specificity 89.5% and the cut-off value was 392.5 µmol/l; while the AUC of the ESR level was 0.864, the sensitivity 89.2%, the specificity 88.5% and the cut-off value 72.8 mm/1 h. Logistic regression analysis showed that the levels of Scr (OR=2.315, P<0.01) and ESR (OR=1.847, P<0.01) were independent factors affecting the prognosis of patients. Based on our findings, the seric Scr level and the ESR are closely related to the clinicopathological features of the disease in patients with renal injury caused by ANCA-associated vasculitis, and they can be used as prognosis and treatment evaluation markers.

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Successful Management of Lupus Nephritis with High Titers of Myeloperoxidase Anti-Neutrophil Cytoplasmic Antibodies Using Tacrolimus

Cited by 6 publications

References 13 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

ANCA-Associated Necrotizing Glomerulonephritis Overlapping with Mesangial Proliferative Lupus Nephritis Refractory to Plasmapheresis, Steroid Pulse Therapy, and a Combination of Mycophenolate Mofetil and Rituximab

Serum creatinine level and ESR values associated to clinical pathology types and prognosis of patients with renal injury caused by ANCA-associated vasculitis

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