Abstract：Objective To study the clinicopathological features of children with lupus nephritis (LN) with positive anti-neutrophil cytoplasmic antibody (ANCA). Methods A retrospective analysis was performed for the children who were diagnosed with LN in the First Affiliated Hospital of Sun Yat-sen University from January 2003 to December 2019. According to the results of serum ANCA, they were divided into two groups: ANCA-positive group (n=59) and ANCAnegative group (n=454). The two groups were compared in terms of clinical manifestations, histopathological features, remission rate, and prognosis. Results Compared with the ANCA-negative group, the ANCA-positive group had a significant reduction in leukocytes and a significant increase in erythrocyte sedimentation rate (P < 0.05). There were no significant differences between the two groups in serum creatinine, urine protein, and urine red blood cell count (P > 0.05). A total of 308 children underwent kidney biopsy. The results on light microscopy showed that compared with the ANCAnegative group, the ANCA-positive group had a significantly higher proportion of children with cellular fibrous crescents (P < 0.05) and a significantly lower proportion of children with immune complex deposition (P < 0.05). There were no significant differences between the two groups in the remission rate and survival rate (P > 0.05). Conclusions Children with ANCA-positive LN tend to have more severe renal pathological injury, which is not exactly parallel with clinical manifestations, suggesting that timely renal biopsy is of great importance.
WEN Si-Jia,CHEN Li-Zhi,CHENG Cheng et al. Clinicopathological features of children with lupus nephritis with positive antineutrophil cytoplasmic antibody[J]. CJCP, 2021, 23(1): 55-60.
Moiseev S, Cohen Tervaert JW, Arimura Y, et al. 2020 international consensus on ANCA testing beyond systemic vasculitis[J]. Autoimmun Rev, 2020, 19(9):102618.
[4]
Wang S, Shang J, Xiao J, et al. Clinicopathologic characteristics and outcomes of lupus nephritis with positive antineutrophil cytoplasmic antibody[J]. Ren Fail, 2020, 42(1):244-254.
[5]
Pyo JY, Jung SM, Song JJ, et al. ANCA positivity at the time of renal biopsy is associated with chronicity index of lupus nephritis[J]. Rheumatol Int, 2019, 39(5):879-884.
[6]
Brunner HI, Gladman DD, Ibañez D, et al. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus[J]. Arthritis Rheum, 2008, 58(2):556-562.
Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus[J]. Arthritis Rheum, 1997, 40(9):1725.
Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited[J]. J Am Soc Nephrol, 2004, 15(2):241-250.
Austin HA 3rd, Muenz LR, Joyce KM, et al. Prognostic factors in lupus nephritis. Contribution of renal histologic data[J]. Am J Med, 1983, 75(3):382-391.
[13]
Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 update of the joint European League against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis[J]. Ann Rheum Dis, 2020, 79(6):713-723.
[14]
Nasr SH, D'Agati VD, Park HR, et al. Necrotizing and crescentic lupus nephritis with antineutrophil cytoplasmic antibody seropositivity[J]. Clin J Am Soc Nephrol, 2008, 3(3):682-690.
Wenderfer SE, Ruth NM, Brunner HI. Advances in the care of children with lupus nephritis[J]. Pediatr Res, 2017, 81(3):406-414.
[17]
Davidson A, Aranow C, Mackay M. Lupus nephritis:challenges and progress[J]. Curr Opin Rheumatol, 2019, 31(6):682-688.
[18]
Li C, Zhou ML, Liang DD, et al.Treatment and clinicopathological characteristics of lupus nephritis with antineutrophil cytoplasmic antibody positivity:a case-control study[J]. BMJ Open, 2017, 7(7):e015668.
[19]
Masani NN, Imbriano LJ, D'Agati VD, et al. SLE and rapidly progressive glomerulonephritis[J]. Am J Kidney Dis, 2005, 45(5):950-955.
[20]
Wang Y, Huang X, Cai J, et al. Clinicopathologic characteristics and outcomes of lupus nephritis with antineutrophil cytoplasmic antibody:a retrospective study[J]. Medicine (Baltimore), 2016, 95(4):e2580.
[21]
Hilhorst M, van Paassen P, Tervaert JW, et al. Proteinase 3-ANCA vasculitis versus myeloperoxidase-ANCA vasculitis[J]. J Am Soc Nephrol, 2015, 26(10):2314-2327.
