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.
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.
LI Lei, ZHANG Zhi-Quan, ZHENG Cheng-Zhong, SHI Yuan, Pediatric Disaster Branch of Chinese Pediatric Society of Chinese Medical Association, Pediatric Branch of Chinese People's Liberation Army. Expert consensus on the prevention and treatment of drowning in children[J]. CJCP, 2021, 23(1): 12-17.
