Clinicopathological features of antineutrophil cytoplasmic antibodies-associated vasculitis in Japanese patients with IgA nephropathy

Shimizu, Miho; Wada, Takashi; Sakai, Norihiko; Izumiya, Yoshiaki; Furuichi, Kengo; Misaki, Tsugiho; Kobayashi, Kenichi; Goshima, Satoshi; Takeda, Shin‐ichi; Yokoyama, Hitoshi

doi:10.1007/s101570070030

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…However, whether immune complex containing IgA could lead to production of ANCA remains debated. Elevation of serum tumour necrosis factor-α, soluble forms of intercellular adhesion molecule 1 and urinary interleukin-8 levels could be detected in the acute or deteriorating phase of IgAN [ 22 – 24 ], which could possibly result in the activation of polyclonal B cells and in the formation of ANCA [ 15 ]. However, we found that IgAN patients with ANCA positivity were relatively older than ANCA-negative patients, and the presence of ANCA was rarely seen even in the acute or deteriorating phase of IgAN.…”

Section: Discussionmentioning

confidence: 99%

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Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case–control study

et al. 2015

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BackgroundThe coexistence of IgA nephropathy (IgAN) and antineutrophil cytoplasmic autoantibodies (ANCAs) is relatively rare. Only a few studies have reported the features of these patients.MethodsWe studied the clinical and histological features of 20 ANCA-positive IgAN patients. They were compared with ANCA-negative IgAN patients (n = 40) and ANCA-associated systemic vasculitis (AASV) patients (n = 40) with a randomly selected and matched proportion of crescentic glomeruli. Furthermore, 9 ANCA-positive crescentic IgAN patients out of the 20 cases were compared with two control groups with crescentic nephritis.ResultsANCA-positive IgAN patients showed older age, lower haemoglobin and higher inflammatory indicator levels at baseline, and a higher percentage of general symptoms and pulmonary involvement, compared with ANCA-negative IgAN patients, and were comparable to AASV patients. Histologically, there was a significantly higher percentage of fibrinoid necrosis in glomeruli in ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN patients (35, 25 and 0%, respectively, P = 0.003). After immunosuppressive therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative crescentic IgAN patients.ConclusionsIgAN patients with ANCA positivity showed more severe clinical and histological features when compared with ANCA-negative IgAN patients and were comparable to AASV patients. However, renal prognosis was relatively better in ANCA-positive crescentic IgAN patients after aggressive immunosuppressive therapy in the short term, compared with ANCA-negative patients.

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Section: Discussionmentioning

confidence: 99%

“…No more than 30 cases with IgAN and coexisting IgG-ANCA positivity have been reported to date, mainly case reports [ 1 – 15 ] and two case series [ 16 , 17 ]. O'Donoghue found that 2% of patients with IgAN showed serum IgG-ANCA positivity.…”

Section: Introductionmentioning

confidence: 99%

Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case–control study

et al. 2015

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“…A case of an adult renal allograft recipient with recurrent IgA nephropathy has been reported, where IgA-ANCA but not IgG-ANCA, was increased after renal transplantation, suggesting that IgA-ANCA might be associated with disease activity. 4 Shimizu et al 5 suggest that the detection of IgM-ANCA in IgA nephropathy may have a close relationship with the extrarenal symptoms of systemic vasculitis, as well as the renal involvement. In previous reports, most cases of IgG-ANCA (MPO-ANCA)-positive IgA nephropathy seem to have been severe, with crescent formation in glomeruli and elevated serum creatinine levels having been observed (Table 3).…”

Section: Discussionmentioning

confidence: 98%

“…14 Upregulation of these cytokines and adhesion molecules may induce polyclonal B-cell activation and amplify ANCA production, leading to crescent formation with necrotizing vasculitis. 5 It was reported that serum TNF-α, ICAM-1, and urinary IL-8 were elevated in patients with acute onset or exacerbation of IgA nephropathy. 15,16 When tonsillitis occurs, patients with IgA nephropathy often develop hematuria and acute lesions such as cellular crescent formation and blood capillary necrosis.…”

Section: Discussionmentioning

confidence: 99%

MPO-ANCA-positive IgA nephropathy successfully treated with tonsillectomy

et al. 2007

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A 20-year-old Japanese woman was admitted to a hospital because of gross hematuria. She was diagnosed with IgA nephropathy with a poor prognosis, based on the formation of many crescents in the glomerulus and monocyte infiltration in the interstitium in a renal biopsy specimen in February 2003. Myeloperoxidase (MPO)-antineutrophil cytoplasmic antibody (ANCA) was not identified at that time. After treatment with high-dose steroid pulse therapy and heparin/warfarin, her urinary protein improved, to 0.5 g/day. However, 1 year after the steroid pulse therapy, urinary protein was increased to 1.2 g/day, associated with repeated episodes of tonsillitis. A second renal biopsy was performed, and showed an improving tendency, compared to the findings of the previous one, although some crescent formation and adhesions of Bowman's capsule remained. Interestingly, MPO-ANCA was positive in the serological examination done at this time. One month and a half after the second renal biopsy, she had a tonsillectomy, followed by a regimen of 5 mg oral prednisolone daily, in order to prevent the progression of IgA nephropathy. After the tonsillectomy, her urinary protein level was markedly improved, at 0.14 g/day. Her creatinine clearance was ameliorated, at 102 ml/min, and in addition, MPO-ANCA had disappeared. This case suggests that an inflammation such as tonsillitis may be associated not only with the activity of IgA nephropathy but also with the production of MPO-ANCA.

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“…Usually, the kidney involved by AAV is often characterized by pauci-immune glomerulonephritis, but there is increasing evidence that immune complex deposition can coexist with ANCA-associated glomerulonephritis. Some studies suggested that immune complexes might appear in the early stage of vasculitis and take part in the occurrence of ANCA and the activation of inflammatory reaction, and then initiated to activation of polyclonal B cells and formation of ANCA [3, 31]. In time, the existence of ANCA would aggravate the inflammatory reaction and lead to pauci-immune injury.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Features and Outcomes of IgA Nephropathy with Serum Antineutrophil Cytoplasmic Autoantibody Positivity

Li,

Chen,

Chen

et al. 2023

Am J Nephrol

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Objective: IgA nephropathy (IgAN) with serum Antineutrophil Cytoplasmic Autoantibody (ANCA) positivity is uncommon. This study analyzed the clinicopathologic features and prognosis of IgAN patients with serum ANCA positivity. Methods: 2864 IgAN patients were tested for ANCA by the indirect immunofluorescence assay and chemiluminescence immunoassay. Patients with serum ANCA positivity (n=85) were identified and their clinical, pathological and prognostic characteristics were analyzed. They were compared with ANCA negative IgAN patients (n=170) and ANCA-associated systemic vasculitis (AAV) with renal involvement patients (n=85) selected randomly. Result：2.97% (85/2864) of IgAN were ANCA positive and 4 patients were diagnosed as crescentic IgAN with ANCA positivity. The clinicopathological characteristics of ANCA-positive IgAN patients were comparable to ANCA-negative IgAN patients, but they had higher antinuclear antibodies (ANA) positive rates and lower levels of renal interstitial inflammation and less immune depositions than ANCA-negative IgAN patients. Compared with AAV patients, ANCA-positive IgAN patients were younger, fewer extrarenal manifestations, milder renal damage and more immune complexes depositions. The renal outcomes were similar between IgAN patients with and without ANCA positivity. Multivariate Cox analysis revealed that in IgAN patients with ANCA positivity, male, ANA positivity, higher serum creatinine and proteinuria, and more severe renal tubular atrophy/interstitial fibrosis were risk factors for adverse renal outcomes. Conclusion: The clinical, pathological features and prognosis of ANCA-positive IgAN patients were similar with ANCA-negative IgAN patients except for higher ANA positive rate, milder renal inflammation and less immune depositions. ANA positivity was an independent risk factor for adverse renal outcomes in ANCA-positive IgAN patients.

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Clinicopathological features of antineutrophil cytoplasmic antibodies-associated vasculitis in Japanese patients with IgA nephropathy

Cited by 5 publications

References 23 publications

Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case–control study

Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective case–control study

MPO-ANCA-positive IgA nephropathy successfully treated with tonsillectomy

Clinicopathological Features and Outcomes of IgA Nephropathy with Serum Antineutrophil Cytoplasmic Autoantibody Positivity

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