Cargando…

The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment

Background: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. The concomitant presence of both crescentic proliferation and anti-neutrophil cytoplasmic autoantibodies (ANCA) in this pathology represents a rare coincidence. However, it is not clear to what extent th...

Descripción completa

Detalles Bibliográficos
Autores principales: Agraz, Irene, Castañeda, Zaira, Sanz-Martínez, María Teresa, Gabaldón, Alejandra, Bermejo, Sheila, Viñas Gimenez, Laura, Bury, Roxana, Bolufer, Mónica, López-Martínez, Marina, Ramos, Natalia, Bestard, Oriol, Soler, María José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9738508/
https://www.ncbi.nlm.nih.gov/pubmed/36498699
http://dx.doi.org/10.3390/jcm11237122
_version_ 1784847561472868352
author Agraz, Irene
Castañeda, Zaira
Sanz-Martínez, María Teresa
Gabaldón, Alejandra
Bermejo, Sheila
Viñas Gimenez, Laura
Bury, Roxana
Bolufer, Mónica
López-Martínez, Marina
Ramos, Natalia
Bestard, Oriol
Soler, María José
author_facet Agraz, Irene
Castañeda, Zaira
Sanz-Martínez, María Teresa
Gabaldón, Alejandra
Bermejo, Sheila
Viñas Gimenez, Laura
Bury, Roxana
Bolufer, Mónica
López-Martínez, Marina
Ramos, Natalia
Bestard, Oriol
Soler, María José
author_sort Agraz, Irene
collection PubMed
description Background: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. The concomitant presence of both crescentic proliferation and anti-neutrophil cytoplasmic autoantibodies (ANCA) in this pathology represents a rare coincidence. However, it is not clear to what extent the presence of ANCA (IgA or IgG) in these patients could have any clinical significance. The aim of the current work is to describe the presence of ANCA (IgA or IgG) in patients with IgAN and crescentic proliferation and its possible clinical implications. Methods: We retrospectively recruited all patients in our center with a histological diagnosis of IgAN with crescentic proliferation between January 2013 and December 2020. The main demographic and clinicopathologic data, fundamental histological characteristics, as well as the treatments implemented and main kidney outcomes, were collected and analyzed at a 6 and 12-month follow-up. Results: Between January 2013 and December 2020, a total of 17 adults were diagnosed with concomitant crescentic proliferation through a kidney biopsy of IgAN. Five (29.4%) patients showed ANCA, three (60%) showed IgA-ANCA and two (40%) showed IgG-ANCA. All ANCA-positive patients had some degree of crescentic proliferation. At diagnosis, the mean age of patients was 48 years old (range: 27–75). Nine of them were women (52%) and the most common clinical presentation was hypertension (71%). At the time of biopsy, the mean serum creatinine and proteinuria were 2.2 mg/dL (DS 1.42) and 3.5 g/mgCr (DS 1.22), respectively, with no statistical differences between ANCA-positive and -negative patients. Histological analyses showed that 11 out of the 12 (91%) ANCA-negative IgAN patients displayed less than 25% cellular crescents, whereas 100% of ANCA-positive IgAN patients displayed more than 25% cellular crescents (p = 0.04). Notably, five (30%) patients displayed fibrinoid necrosis, with four of them (80%) being IgAN-ANCA-positive (p = 0.01). Only one ANCA-negative patient needed renal replacement therapy (RRT) upon admission (5%). The mean serum creatinine and proteinuria were 1.94 mg/dL (DS 1.71) and 1.45 g/gCr (DS 1.78), respectively, within 6 months of immunosuppressive therapy. At 12-month follow-up, the mean creatinine was 1.57 mg/dL (DS 1). Four (23.5%) patients needed RRT at the end of the follow-up and four (23.5%) patients died. Conclusions: Probably due to the limited number of IgAN-ANCA-positive and IgAN-ANCA-negative patients, no significant differences were found between the clinical and laboratory characteristics. IgAN-ANCA-negative patients seemed to display less extracapillary proliferation than IgAN-ANCA-positive patients, who tended to show significantly higher fibrinoid necrosis. There were no differences regarding renal prognosis and patient survival after aggressive immunosuppressive therapy within 6 and 12 months when comparing the two samples.
format Online
Article
Text
id pubmed-9738508
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-97385082022-12-11 The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment Agraz, Irene Castañeda, Zaira Sanz-Martínez, María Teresa Gabaldón, Alejandra Bermejo, Sheila Viñas Gimenez, Laura Bury, Roxana Bolufer, Mónica López-Martínez, Marina Ramos, Natalia Bestard, Oriol Soler, María José J Clin Med Article Background: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide. The concomitant presence of both crescentic proliferation and anti-neutrophil cytoplasmic autoantibodies (ANCA) in this pathology represents a rare coincidence. However, it is not clear to what extent the presence of ANCA (IgA or IgG) in these patients could have any clinical significance. The aim of the current work is to describe the presence of ANCA (IgA or IgG) in patients with IgAN and crescentic proliferation and its possible clinical implications. Methods: We retrospectively recruited all patients in our center with a histological diagnosis of IgAN with crescentic proliferation between January 2013 and December 2020. The main demographic and clinicopathologic data, fundamental histological characteristics, as well as the treatments implemented and main kidney outcomes, were collected and analyzed at a 6 and 12-month follow-up. Results: Between January 2013 and December 2020, a total of 17 adults were diagnosed with concomitant crescentic proliferation through a kidney biopsy of IgAN. Five (29.4%) patients showed ANCA, three (60%) showed IgA-ANCA and two (40%) showed IgG-ANCA. All ANCA-positive patients had some degree of crescentic proliferation. At diagnosis, the mean age of patients was 48 years old (range: 27–75). Nine of them were women (52%) and the most common clinical presentation was hypertension (71%). At the time of biopsy, the mean serum creatinine and proteinuria were 2.2 mg/dL (DS 1.42) and 3.5 g/mgCr (DS 1.22), respectively, with no statistical differences between ANCA-positive and -negative patients. Histological analyses showed that 11 out of the 12 (91%) ANCA-negative IgAN patients displayed less than 25% cellular crescents, whereas 100% of ANCA-positive IgAN patients displayed more than 25% cellular crescents (p = 0.04). Notably, five (30%) patients displayed fibrinoid necrosis, with four of them (80%) being IgAN-ANCA-positive (p = 0.01). Only one ANCA-negative patient needed renal replacement therapy (RRT) upon admission (5%). The mean serum creatinine and proteinuria were 1.94 mg/dL (DS 1.71) and 1.45 g/gCr (DS 1.78), respectively, within 6 months of immunosuppressive therapy. At 12-month follow-up, the mean creatinine was 1.57 mg/dL (DS 1). Four (23.5%) patients needed RRT at the end of the follow-up and four (23.5%) patients died. Conclusions: Probably due to the limited number of IgAN-ANCA-positive and IgAN-ANCA-negative patients, no significant differences were found between the clinical and laboratory characteristics. IgAN-ANCA-negative patients seemed to display less extracapillary proliferation than IgAN-ANCA-positive patients, who tended to show significantly higher fibrinoid necrosis. There were no differences regarding renal prognosis and patient survival after aggressive immunosuppressive therapy within 6 and 12 months when comparing the two samples. MDPI 2022-11-30 /pmc/articles/PMC9738508/ /pubmed/36498699 http://dx.doi.org/10.3390/jcm11237122 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Agraz, Irene
Castañeda, Zaira
Sanz-Martínez, María Teresa
Gabaldón, Alejandra
Bermejo, Sheila
Viñas Gimenez, Laura
Bury, Roxana
Bolufer, Mónica
López-Martínez, Marina
Ramos, Natalia
Bestard, Oriol
Soler, María José
The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title_full The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title_fullStr The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title_full_unstemmed The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title_short The Presence of ANCA in IgA Crescentic Nephropathy Does Not Lead to Worse Prognosis with Intensive Rescue Treatment
title_sort presence of anca in iga crescentic nephropathy does not lead to worse prognosis with intensive rescue treatment
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9738508/
https://www.ncbi.nlm.nih.gov/pubmed/36498699
http://dx.doi.org/10.3390/jcm11237122
work_keys_str_mv AT agrazirene thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT castanedazaira thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT sanzmartinezmariateresa thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT gabaldonalejandra thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bermejosheila thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT vinasgimenezlaura thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT buryroxana thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bolufermonica thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT lopezmartinezmarina thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT ramosnatalia thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bestardoriol thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT solermariajose thepresenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT agrazirene presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT castanedazaira presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT sanzmartinezmariateresa presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT gabaldonalejandra presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bermejosheila presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT vinasgimenezlaura presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT buryroxana presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bolufermonica presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT lopezmartinezmarina presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT ramosnatalia presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT bestardoriol presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment
AT solermariajose presenceofancainigacrescenticnephropathydoesnotleadtoworseprognosiswithintensiverescuetreatment