Proteinase-3 and myeloperoxidase serotype in relation to demographic factors and geographic distribution in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis

Weiner, Maria; Bjørneklett, Rune; Hrušková, Zdenka; Mackinnon, Bruce; Poulton, Caroline J.; Sindelar, Leo; Mohammad, Aladdin J; Eriksson, Per; Gesualdo, Loreto; Geetha, Duvuru; Crnogorac, Matija; Jayne, David; Hogan, Susan L.; Geddes, Colin; Tesař, Vladimı́r; Aasarød, Knut; Segelmark, Mårten

doi:10.1093/ndt/gfy106

Cited by 26 publications

(35 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast to the literature 14,21 , we identi ed that MPO-ANCA is more prevalent than PR3-ANCA in males. We also identi ed a higher proportion of MPO-ANCA positivity overall (60.1%) compared to the Norwegian study (46.0%), which is in keeping with the known latitudinal gradient of PR3:MPO ANCA speci city 21 . This highlights the heterogenous nature of AAV across different geographic regions, despite using identical inclusion criteria.…”

Section: Discussioncontrasting

confidence: 97%

A Cohort Study to Investigate Sex-specific Differences in ANCA-associated Glomerulonephritis Outcomes

Scott

Canepa

Buettner

et al. 2021

Preprint

View full text Add to dashboard Cite

IntroductionData surrounding sex-specific differences in ANCA-associated vasculitis glomerulonephritis (ANCA-GN) outcomes is sparse. We hypothesised that the previously observed increased risk of end-stage kidney disease (ESKD) in males is driven by sex-specific variation in immunosuppression dosing.MethodsPatients were recruited to the Irish Rare Kidney Disease Registry or followed by the Royal Free Hospital vasculitis team (2012-2020). Inclusion criteria: prior diagnosis of ANCA-GN (biopsy proven pauci-immune glomerulonephritis) and positive serology for anti-MPO or –PR3 antibodies. Renal and patient survival, stratified by sex and Berden histological class, was analysed. The cumulative- and starting dose/kilogram of induction agents and prednisolone, respectively, was compared between sexes. Results332 patients were included. Median follow-up was time 40.2 months (IQR 17.3–69.2). 73 (22%) reached ESKD and 47 (14.2%) died. Overall 1- and 5-year renal survival was 82.2% and 76.7% in males and 87.1% and 82.0% in females, respectively (p 0.13). The hazard ratio for ESKD in males versus females, after adjustment for age, ANCA serology, baseline creatinine and histological class was 1.07 (95% CI 0.59–1.93). There was no difference between sexes in the dose/kilogram of any induction agent.ConclusionWe did not observe a strong impact of sex on renal outcome in ANCA-GN. Treatment intensity does not vary by sex.

show abstract

Section: Discussioncontrasting

confidence: 97%

A Cohort Study to Investigate Sex-specific Differences in ANCA-associated Glomerulonephritis Outcomes

Scott

Canepa

Buettner

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…One such variation would include differences in sunlight exposure; UV radiation level has been shown to correlate with ANCA serotype. 2 The climate in Scotland infers there is less variability in sunlight across seasons in contrast to Spain.…”

Section: Discussionmentioning

confidence: 99%

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundSmall studies suggest an association between ANCA-associated vasculitis (AAV) incidence and rurality, seasonality and socioeconomic deprivation. We examined the incidence of kidney biopsy-proven AAV and its relationship with these factors in the adult Scottish population.MethodsUsing the Scottish Renal Biopsy Registry, all adult native kidney biopsies performed between 2014 and 2018 with a diagnosis of granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) were identified. The Scottish Government Urban Rural Classification was used for rurality analysis. Seasons were defined as autumn (September–November), winter (December–February), spring (March–May) and summer (June–August). Patients were separated into quintiles of socioeconomic deprivation using the validated Scottish Index of Multiple Deprivation and incidence standardised to age. Estimated glomerular filtration rate and urine protein:creatinine ratio at time of biopsy were used to assess disease severity.Results339 cases of renal AAV were identified, of which 62% had MPA and 38% had GPA diagnosis. AAV incidence was 15.1 per million population per year (pmp/year). Mean age was 66 years and 54% were female. Incidence of GPA (but not MPA) was positively associated with rurality (5.2, 8.4 and 9.1 pmp/year in ‘urban’, ‘accessible remote’ and ‘rural remote’ areas, respectively; p=0.04). The age-standardised incidence ratio was similar across all quintiles of deprivation (p=ns).ConclusionsSeasonality and disease severity did not vary across AAV study groups. In this complete national cohort study, we observed a positive association between kidney biopsy-proven GPA and rurality.

show abstract

“…ANCA status is also a major determinant of the clinical presentation. Although all age groups can be affected, PR3-ANCA positive patients are on average 10 years younger than patients with MPO-ANCA; likewise, PR3-ANCA is significantly associated with male gender [ 33 , 34 ]. Ethnicity has a role in disease manifestation, as illustrated by the predominance of MPO-ANCA among patients with either GPA or MPA in Asia.…”

Section: Differences In Demographic Factors and Manifestationmentioning

confidence: 99%

“…Renal vasculitis, i.e., pauci-immune rapidly progressive crescentic GN, is a common manifestation of AAV, affecting > 75% of patients in the early course of the disease [ 37 , 38 ]. Seen from the other side, AAV-GN accounts for the majority (e.g., 80% in a contemporary Korean cohort [ 34 ]) of cases of crescentic GN. It carries an unfavorable prognosis, as it confers increased risks of end-stage kidney disease (ESKD) and mortality [ 15 , 39 , 40 ].…”

Section: Kidney Involvementmentioning

confidence: 99%

ANCA Status or Clinical Phenotype — What Counts More?

et al. 2021

Self Cite

View full text Add to dashboard Cite

Purpose of Review There is ongoing debate concerning the classification of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. That is, whether classification should be based on the serotype (proteinase 3 (PR3)- or myeloperoxidase (MPO)-ANCA) or on the clinical phenotype (granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)). To add clarity, this review focused on integration of the most recent literature. Recent Findings Large clinical trials have provided evidence that a serology-based risk assessment for relapses is more predictive than distinction based on the phenotype. Research conducted in the past decade indicated that a serology-based approach more closely resembles the genetic associations, the clinical presentation (i.e., lung involvement), biomarker biology, treatment response, and is also predicting comorbidities (such as cardiovascular death). Summary Our review highlights that a serology-based approach could replace a phenotype-based approach to classify ANCA-associated vasculitides. In future, clinical trials and observational studies will presumably focus on this distinction and, as such, translate into a “personalized medicine.”

show abstract

Proteinase-3 and myeloperoxidase serotype in relation to demographic factors and geographic distribution in anti-neutrophil cytoplasmic antibody-associated glomerulonephritis

Abstract: The ratio between PR3-ANCA and MPO-ANCA varies in glomerulonephritis with respect to age, gender, renal function and geographic latitude/UV radiation levels.

Cited by 26 publications

References 44 publications

A Cohort Study to Investigate Sex-specific Differences in ANCA-associated Glomerulonephritis Outcomes

A Cohort Study to Investigate Sex-specific Differences in ANCA-associated Glomerulonephritis Outcomes

ANCA-associated renal vasculitis is associated with rurality but not seasonality or deprivation in a complete national cohort study

ANCA Status or Clinical Phenotype — What Counts More?

Contact Info

Product

Resources

About