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Clinical aspects

 

ANCA-associated pauci-immune glomerulonephritis: always pauci-immune?

1, 2, 3, 4, 5, 6, 7, 8

 

  1. Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina. valeria.scaglioni@hospitalitaliano.org.ar
  2. Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  3. Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  4. Pathology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  5. Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  6. Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  7. Nephrology Service, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
  8. Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.

CER9859
2017 Vol.35, N°1 ,Suppl.103
PI 0055, PF 0058
Clinical aspects

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PMID: 28229825 [PubMed]

Received: 19/08/2016
Accepted : 03/01/2017
In Press: 31/01/2017
Published: 19/04/2017

Abstract

OBJECTIVES:
Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) is considered “pauci-immune” with absent or mild glomerular tuft staining for immunoglobulin (Ig) and/or complement. However, it is not unusual to see some immune deposits (ID) within glomeruli on immunofluorescence (IF). We determined to evaluate the prevalence and clinical significance of immune deposits in ANCA-associated GN.
METHODS:
We included all patients with ANCA associated vasculitis with renal biopsies between January 2002 and May 2014: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis and renal limited vasculitis. Patients were divided into Group A: biopsy without ID (≤2+ intensity of immunostaining) and Group B: biopsy with ID (>2+ intensity of immunostaining). Serum creatinine, estimated glomerular filtration rate (eGFR) at time of the biopsy, amount of proteinuria and hematuria, requirement of dialysis and extra renal involvement were recorded.
RESULTS:
Fifty-three patients (75.4% females) were included. Mean age at biopsy was 66.3 years. Typical pauci-immune GN was found in 39 patients (73.5%, group A). In 14 patients (26.4%, group B) examination revealed substantial deposition of Ig or complement in the mesangium and/or along the glomerular capillary wall. The only difference comparing both groups was significantly higher proteinuria in group B (mean 1.6/24 h (SD: 10.7) vs. 0.8/24 h (SD: 7.6), p=0.0036).
CONCLUSIONS:
In ANCA GN at least a quarter of patients were not “pauci-immune” (26.4%). In this subgroup, immune deposits were only associated with a significantly higher proteinuria. Further basic and clinical research is needed to elucidate the significance of immune deposition in ANCA GN.

Rheumatology Article