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2015 ; 8
(5
): 482-8
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Clinical features of IgA nephropathy with serum ANCA positivity: a retrospective
case-control study
#MMPMID26413270
Yang YZ
; Shi SF
; Chen YQ
; Chen M
; Yang YH
; Xie XF
; Zou R
; Lv JC
; Liu LJ
; Zhang H
Clin Kidney J
2015[Oct]; 8
(5
): 482-8
PMID26413270
show ga
BACKGROUND: The coexistence of IgA nephropathy (IgAN) and antineutrophil
cytoplasmic autoantibodies (ANCAs) is relatively rare. Only a few studies have
reported the features of these patients. METHODS: We studied the clinical and
histological features of 20 ANCA-positive IgAN patients. They were compared with
ANCA-negative IgAN patients (n = 40) and ANCA-associated systemic vasculitis
(AASV) patients (n = 40) with a randomly selected and matched proportion of
crescentic glomeruli. Furthermore, 9 ANCA-positive crescentic IgAN patients out
of the 20 cases were compared with two control groups with crescentic nephritis.
RESULTS: ANCA-positive IgAN patients showed older age, lower haemoglobin and
higher inflammatory indicator levels at baseline, and a higher percentage of
general symptoms and pulmonary involvement, compared with ANCA-negative IgAN
patients, and were comparable to AASV patients. Histologically, there was a
significantly higher percentage of fibrinoid necrosis in glomeruli in
ANCA-positive IgAN patients and in AASV patients compared with ANCA-negative IgAN
patients (35, 25 and 0%, respectively, P = 0.003). After immunosuppressive
therapy, ANCA-positive crescentic IgAN patients were more likely to withdraw from
dialysis (75 versus 9.1%, P = 0.03) and not to reach end-stage renal disease
within 6 months (11.1 versus 66.7%, P = 0.01) compared with ANCA-negative
crescentic IgAN patients. CONCLUSIONS: IgAN patients with ANCA positivity showed
more severe clinical and histological features when compared with ANCA-negative
IgAN patients and were comparable to AASV patients. However, renal prognosis was
relatively better in ANCA-positive crescentic IgAN patients after aggressive
immunosuppressive therapy in the short term, compared with ANCA-negative
patients.