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Impact of Proteinase 3 versus Myeloperoxidase Positivity on Risk of End-Stage
Renal Disease in ANCA-Associated Glomerulonephritis Stratified by Histological
Classification: A Population-Based Cohort Study
#MMPMID29854025
Solbakken V
; Fismen AS
; Bostad L
; Bjørneklett R
Dis Markers
2018[]; 2018
(?): 3251517
PMID29854025
show ga
BACKGROUND: End-stage renal disease (ESRD) risk in patients with antineutrophil
cytoplasmic antibody- (ANCA-) associated glomerulonephritis (ANCA-GN) according
to ANCA serotype and stratified by histological classification has not been
previously investigated. METHODS: Patients from the Norwegian Kidney Biopsy
Registry (NKBR) between 1991 and 2012 who had biopsy-verified pauci-immune
glomerulonephritis and positive antineutrophil cytoplasmic antibody serology were
included. Cases with ESRD during follow-up were identified in the Norwegian Renal
Registry. ESRD-free survival with proteinase 3 (PR3) versus myeloperoxidase-
(MPO-) ANCA positivity stratified into 4 histological classes was investigated.
RESULTS: Three hundred fifty-eight patients, of whom 87 progressed to ESRD during
follow-up, were included. Patients with PR3- as compared to MPO-ANCA were younger
(58 versus 64 years, p = 0.001), had a higher percentage of males (62 versus 41%,
p < 0.001), had a lower percentage with a sclerozing glomerulonephritis pattern
(4 versus 16%, p < 0.001), and had a significantly higher cumulative ESRD-free
survival (90 versus 80%, p = 0.007) at 1-year follow-up. No significant
differences in cumulative ESRD-free survival with PR3- as compared to MPO-ANCA
were observed by histological stratification. CONCLUSION: Advanced glomerular
sclerosis is found more frequently in patients with MPO-ANCA, explaining the
higher risk of ESRD. ANCA serotypes have no impact on prognosis of patients with
similar histological findings.