Relationship between serologic profile (ANCA type) and clinical features of renal involvement in ANCA-associated vasculitides


Cite item

Full Text

Abstract

Objective. To compare the frequency, clinical features and outcomes of renal involvement in ANCA-associated vasculitides (AAV) in patients with antibodies against proteinase-3 (pr3-ANCA) and myeloperoxidase (MPO-ANCA). Materials and methods. In our retrospective study we enrolled 264 patients, 94 males and 170 females, median age 53 [36; 62] years. Among them 157 were pr3-ANCA positive and 107 were MPO-ANCA positive. AAV was diagnosed according to ACR criteria and Chapel Hill consensus conference definition (2012). Median follow up was 44 [18; 93] months. We assessed baseline BVAS and VDI by the end of the follow up. Serum creatinine (sCr), estimated glomerular filtration rate (eGFR), hematuria and daily proteinuria were estimated. Diagnosis and stage of chronic kidney disease (CKD) and acute kidney injury (AKI) were established according to KDIGO guidelines (2012) and Scientific Society of Russian Nephrologists (2016). Results. Renal involvement was present in 181 (68.6%) patients, and its frequency was similar in pr3-ANCA and MPO-ANCA subgroups. Patients with MPO-ANCA developed rapidly progressive glomerulonephritis and hypertension significantly more often than patients with pr3-ANCA: 50.7% vs 35.6% (p=0.049) and 46.1% vs 29.8% (p=0.029) respectively. At disease onset, median sCr was significantly higher and eGFR was significantly lower in patients with MPO-ANCA (p<0.05). 1-year and 5-year renal survival rates were similar in pr3-ANCA-positive (93.9% and 87.4% respectively) and MPO-ANCA positive patients (87.4% and 83.1% respectively). Median BVAS and VDI scores were significantly higher in pr3-ANCA subgroup. The number of patients who developed AAV relapse during 1-year follow up was also significantly higher in pr3-ANCA subgroup. The frequency of eye and ENT involvement was significantly higher in pr3-ANCA positive patients than in MPO-ANCA-positive patients. Conclusions: The frequency of extrarenal manifestations, clinical features of renal involvement and relapse rate are associated with AAV serotype.

About the authors

N M Bulanov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: nmbulanov@gmail.com
с.н.с. НИО здоровьесберегающих технологий Первого МГМУ им. И.М. Сеченова, ORCID 0000-0002-3989-2590 Moscow, Russia

E A Makarov

M.V. Lomonosov Moscow State University

ассистент каф. внутренних болезней факультета фундаментальной медицины МГУ им. М.В. Ломоносова Moscow, Russia

E M Shchegoleva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

врач-ревматолог ревматологического отд-ния №1 клиники ревматологии Университетской клинической больницы №3 Первого МГМУ им. И.М. Сеченова Moscow, Russia

A S Zykova

M.V. Lomonosov Moscow State University

аспирант каф. внутренних болезней факультета фундаментальной медицины МГУ им. М.В. Ломоносова Moscow, Russia

E S Vinogradova

M.V. Lomonosov Moscow State University

аспирант каф. внутренних болезней факультета фундаментальной медицины МГУ им. М.В. Ломоносова Moscow, Russia

P I Novikov

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

зав. ревматологическим отд-нием №1 клиники ревматологии Университетской клинической больницы №3 Первого МГМУ им. И.М. Сеченова Moscow, Russia

L V Lysenko(Kozlovskaya)

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

проф. каф. внутренних, профессиональных болезней и пульмонологии Первого МГМУ им. И.М. Сеченова Moscow, Russia

S V Moiseev

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University); M.V. Lomonosov Moscow State University

директор клиники ревматологии Университетской клинической больницы №3, проф. каф. внутренних, профессиональных болезней и пульмонологии Первого МГМУ им. И.М. Сеченова; проф. каф. внутренних болезней МГУ им. М.В. Ломоносова Moscow, Russia

References

  1. Jennette J.C, Falk R.J, Bacon P.A, Basu N, Cid M.C, Ferrario F, Flores-Suarez L.F, Gross W.L, Guillevin L, Hagen E.C, Hoffman G.S, Jayne D.R, Kallenberg C.G, Lamprecht P, Langford C.A, Luqmani R.A, Mahr A.D, Matteson E.L, Merkel P.A, Ozen S, Pusey C.D, Rasmussen N, Rees A.J, Scott D.G, Specks U, Stone J.H, Takahashi K, Watts R.A. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013. Jan;65(1):1-11. doi: 10.1002/art. 37715
  2. Novikov P, Smitienko I, Bulanov N, Zykova A, Moiseev S. Testing for antineutrophil cytoplasmic antibodies (ANCAs) in patients with systemic vasculitides and other diseases. Ann Rheum Dis. 2017 Aug;76(8):e23. doi: 10.1136/annrheumdis-2016-210890
  3. Lyons P.A, Rayner T.F, Trivedi S, Holle J.U, Watts R.A, Jayne D.R, Baslund B, Brenchley P, Bruchfeld A, Chaudhry A.N, Cohen Tervaert J.W, Deloukas P, Feighery C, Gross W.L, Guillevin L, Gunnarsson I, Harper L, Hrušková Z, Little M.A, Martorana D, Neumann T, Ohlsson S, Padmanabhan S, Pusey C.D, Salama A.D, Sanders J.S, Savage C.O, Segelmark M, Stegeman C.A, Tesař V, Vaglio A, Wieczorek S, Wilde B, Zwerina J, Rees A.J, Clayton D.G, Smith K.G. Genetically Distinct Subsets within ANCA-Associated Vasculitis. N Engl J Med. 2012 Jul 19;367(3):214-23. doi: 10.1056/NEJMoa1108735
  4. Семенкова Е.Н., Бекетова Т.В., Коган Е.А., Козловская Л.В., Мухин Н.А. Современные представления о микроскопическом полиартериите. Терапевтический архив. 1995;67(5):39-41.
  5. Бекетова Т.В. Гранулематоз с полиангиитом, патогенетически связанный с антинейтрофильными цитоплазматическими антителами: особенности клинического течения. Научно - практическая ревматология. 2012;50(6):19-28. doi: 10.14412/1995-4484-2012-1288
  6. Kallenberg C.G. Pathogenesis of ANCA-associated vasculitides. Ann Rheum Dis. 2011;70(Suppl 1):i59-63.
  7. Буланов Н.М., Моисеев С.В., Новиков П.И., Кузнецова Е.И., Мешков А.Д., Макаров Е.А., Козловская Л.В., Мухин Н.А. Поражение почек при различных вариантах АНЦА-ассоциированного васкулита. Клиническая фармакология и терапия. 2016;25(5):23-9.
  8. Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, Flossmann O, Hall C, Hollywood J, Jayne D, Jones R, Lanyon P, Muir A, Scott D, Young L, Luqmani R.A. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis. 2009;68(12):1827-32. doi: 10.1136/ard.2008.101279
  9. Bhamra K, Luqmani R. Damage assessment in ANCA-associated vasculitis. Curr Rheumatol Rep. 2012;14(6):494-500. doi: 10.1007/ s11926-012-0291-1
  10. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3(1):1-150.
  11. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. 2012;2(1):1-141.
  12. Lionaki S, Blyth E.R, Hogan S.L, Hu Y, Senior B.A, Jennette C.E, Nachman P.H, Jennette J.C, Falk R.J. Classification of antineutrophil cytoplasmic autoantibody vasculitides: the role of antineutrophil cytoplasmic autoantibody specificity for myeloperoxidase or proteinase 3 in disease recognition and prognosis. Arthritis Rheum. 2012;64(10): 3452-62. doi: 10.1002/art.34562
  13. Quintana L.F, Peréz N.S, De Sousa E, Rodas L.M, Griffiths M.H, Solé M, Jayne D. ANCA serotype and histopathological classification for the prediction of renal outcome in ANCA-associated glomerulonephritis. Nephrol Dial Transplant. 2014;29(9):1764-9. doi: 10. 1093/ndt/ gfu084
  14. Hauer H.A, Bajema I.M, van Houwelingen H.C, Ferrario F, Noël L.H, Waldherr R, Jayne D.R, Rasmussen N, Bruijn J.A, Hagen E.C; European Vasculitis Study Group (EUVAS). Renal histology in ANCA-associated vasculitis: differences between diagnostic and serologic subgroups. Kidney Int. 2002;61(1):80-9. doi: 10.1046/j.1523-1755.2002. 00089.x
  15. Chang D.Y, Wu L.H, Liu G, Chen M, Kallenberg C.G, Zhao M.H. Re - evaluation of the histopathologic classification of ANCA-associated glomerulonephritis: a study of 121 patients in a single center. Nephrol Dial Transplant. 2012;27(6):2343-9. doi: 10.1093/ndt/gfr643
  16. Murosaki T, Sato T, Akiyama Y, Nagatani K, Minota S. Difference in relapse - rate and clinical phenotype by autoantibody - subtype in Japanese patients with anti - neutrophil cytoplasmic antibody - associated vasculitis. Mod Rheumatol. 2017;27(1):95-101. doi: 10.1080/ 14397595.2016.1192760
  17. Hogan S.L, Falk R.J, Chin H, Cai J, Jennette C.E, Jennette J.C, Nachman P.H. Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody - associated small - vessel vasculitis. Ann Intern Med. 2005;143(9):621-31. doi: 10.7326/0003-4819-143-9-200511010- 00005
  18. Pagnoux C, Hogan S.L, Chin H, Jennette J.C, Falk R.J, Guillevin L, Nachman P.H. Predictors of treatment resistance and relapse in antineutrophil cytoplasmic antibody - associated small - vessel vasculitis: comparison of two independent cohorts. Arthritis Rheum. 2008;58(9): 2908-18. doi: 10.1002/art.23800
  19. Моисеев С.В., Новиков П.И., Мешков А.Д., Иваницкий Л.В. АНЦА-ассоциированные васкулиты: спорные вопросы классификации, диагностики и оценки активности и современные подходы к лечению. Клиническая фармакология и терапия. 2014;23(1): 44-50.

Copyright (c) 2018 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies