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Long-term kidney outcome of patients with rheumatological diseases and antineutrophil cytoplasmic antibody-glomerulonephritis: comparison with a primitive ANCA-glomerulonephritis cohort
L. Locatelli1, M. Calatroni2, F. Reggiani3, G.D. Bonelli4, M. Gerosa5, L.M. Argolini6, B. Trezzi7, N. Del Papa8, C. Angelini9, M.R. Pozzi10, R.A. Sinico11, G. Moroni12
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Nephrology Unit, ASST-Monza, Ospedale San Gerardo, Monza, and Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. marta.calatroni@hunimed.eu
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Nephrology Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy.
- Clinical Rheumatology, Department of Clinical Sciences and Community Health, ASST Pini-CTO, Milan, and University of Milan, Italy.
- Clinical Rheumatology, Department of Clinical Sciences and Community Health, ASST Pini-CTO, Milan, Italy.
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Nephrology Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy.
- Clinical Rheumatology, Department of Clinical Sciences and Community Health, ASST Pini-CTO, Milan, Italy.
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, and Nephrology Unit, ASST-Monza, Ospedale San Gerardo, Monza, and Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
- Rheumatology Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy.
- Rheumatology Unit, ASST-Monza, Ospedale San Gerardo, Monza, Italy.
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
CER15845
2023 Vol.41, N°4
PI 0856, PF 0863
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PMID: 36533986 [PubMed]
Received: 12/05/2022
Accepted : 21/10/2022
In Press: 19/12/2022
Published: 18/04/2023
Abstract
OBJECTIVES:
Antineutrophil cytoplasmic antibody (ANCA) may appear in the course of rheumatic diseases (RD) but the kidney involvement is very rare and the prognosis poorly defined.
METHODS:
We retrospectively identified patients with RD among 153 patients with ANCA glomerulonephritis (ANCA-GN). Their clinical/histological presentation and outcome were compared with that of primitive ANCA-GN patients (1:4) matched for sex, age, ANCA type and follow-up.
RESULTS:
Nine patients (5.9%) were included: three had rheumatoid arthritis, two systemic sclerosis, two psoriatic arthritis, one ankylosing spondylitis and one seronegative spondylarthritis. Seven patients were MPO positive, two PR3 positive. ANCA-GN developed 74 months after RD with microscopic haematuria and acute kidney dysfunction in all but two patients. After 68-month follow-up, four patients (44.4%) achieved response to therapy defined as eGFR >60/min/1,73 m2 or stable, no microscopic haematuria and negative ANCA. At ANCA-GN diagnosis, serum creatinine and C-reactive protein were significantly lower in RD-ANCA-GN (2.38 vs. 3.34mg/dl, p=0.05 and 2.3mg/dl vs. 7.2mg/dl; p=0.05, respectively) while haemoglobin was higher (12.3g/dl vs. 9.3g/dl p<0.01) than in the 36 primitive ANCA-GN patients of control group. At kidney biopsy, focal forms were more frequent in RD patients (44.45% vs. 18.75%, p=0.11). The treatment between the two groups was not significantly different. At last observation, the percentage of patients with ESKD was lower in RD than in controls (11.1%vs. 30.5%; p=0.23).
CONCLUSIONS:
Patients with RD seem to develop ANCA-GN with less severe clinical/histological kidney involvement, and better long-term kidney survival than primitive ANCA-GN. This is probably due to the strict monitoring of RD patients that allows a prompter ANCA-GN diagnosis and treatment.
