Positive antineutrophil cytoplasmic antibody
serology in patients with lupus nephritis is
associated with distinct histopathologic features
on renal biopsy

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Author(s)

Turner-Stokes, T

Wilson, HR

Morreale, M

Nunes, A

Cairns, T

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Type

Journal Article

Abstract

Class IV-S lupus nephritis (LN) is often associated with more necrosis and fewer subendothelial immune deposits compared to class IV-G LN, suggestive of the necrotising glomerular inflammation found in ANCA-associated vasculitis. ANCA are present in a significant proportion of patients with LN. The aim of this study was to determine whether ANCA are associated with distinct clinical and histopathological features of LN. 32 ANCA positive biopsies were compared to 222 ANCA negative biopsies from patients with LN. The majority of ANCA positive patients had anti-MPO antibodies (82%). Class IV-S LN and glomerular necrosis were more common (36% vs. 16%, p=0.0253 and 35% vs. 15%, p=0.025 respectively) and isolated Class V LN less common (10% vs. 29%, p=0.0282) in the ANCA positive group. ANCA positive patients had higher dsDNA titres (335u/ml vs. 52u/ml, p=0.00007), lower serum C4 concentration (0.125g/L vs. 0.15g/L, p=0.027) and higher serum creatinine (130µmol/L vs. 84µmol/L, p=0.047) at time of biopsy. Hence ANCA appear to influence the histological pattern of LN and are associated with worse baseline renal function and more active lupus serology. There was no significant difference in outcome between groups when matched for severity of disease and treatment using propensity scoring. Further studies are needed to examine whether ANCA in patients with LN have a pathogenic role and whether they are associated with worse renal outcomes or are simply a marker of more severe disease.

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Date Issued

2017-07-24

Date Acceptance

2017-04-18

Citation

Kidney International, 2017, 92 (5), pp.1223-1231

URI

http://hdl.handle.net/10044/1/53672

DOI

https://www.dx.doi.org/10.1016/j.kint.2017.04.029

ISSN

1523-1755

Publisher

Elsevier

Start Page

1223

End Page

1231

Journal / Book Title

Kidney International

Volume

92

Issue

5

Copyright Statement

Copyright © 2017, International Society of Nephrology. Published by
Elsevier Inc. This is an open access article under the CC BY license (http://
creativecommons.org/licenses/by/4.0/).

License URL

http://creativecommons.org/licenses/by/4.0/

Sponsor

Arthritis Research UK

Imperial College Healthcare NHS Trust- BRC Funding

Imperial College Healthcare NHS Trust

Grant Number

MP/18235

RDA04 79560

5083

Subjects

Science & Technology

Life Sciences & Biomedicine

Urology & Nephrology

ANCA

glomerulonephritis

renal pathology

systemic lupus erythematosus

ERYTHEMATOSUS

GLOMERULONEPHRITIS

PATHOGENESIS

AUTOANTIBODIES

RITUXIMAB

PROGNOSIS

STEROIDS

1103 Clinical Sciences

Publication Status

Published