Avtor/Urednik | Vizjak, Alenka; Rott, Tomaž; Koselj-Kajtna, Mira; Rozman, Blaž; Kaplan-Pavlovčič, Staša; Ferluga, Dušan | |
Naslov | Histologic and immunohistologic study and clinical presentation of ANCA-associated glomerulonephritis with correlation to ANCA antigen specificity | |
Tip | članek | |
Vir | Am J Kidney Dis | |
Vol. in št. | Letnik 41, št. 3 | |
Leto izdaje | 2003 | |
Obseg | str. 539-49 | |
Jezik | eng | |
Abstrakt | Background: The major antigen specificities of antineutrophil cytoplasmfc antibodies (ANCA) are for proteinase 3 (PR3) and myeloperoxidase (MPO). Only a limited number of studles have systematlcally assessed renal pathology with respect to ANCA antigen specificity. Methods: The authors evaluated renal biopsy light microscopy and immunofluorescence findings, clinical presentation, and outcome In 135 patients with ANCAassociated vasculitides. Results: Patients were divided into 3 groups: PR3-ANCA (n = 55), MPO-ANCA (n = 74), and ANCA of other specificities (n = 6). The mean duration of renal disease at biopsy was significantly longer in patients with MPO-ANCA than in those with PR3-ANCA (6.9 v 3.0 months). Immunofluorescence results showed mostly pauci-immune glomerulonephritis (n = 129) and rarely diffuse granular glomerular immune deposits suggesting immune complex deposition (n = 6). A focal form of crescentic glomerulonephritis was more frequent (P < 0.001), and glomerular necrosis was more prominent (P = 0.013) in the PR3-ANCA group, whereas diffuse crescentic glomerulonephritis, glomerulosclerosis, and interstitial fibrosis predominated in the MPO-ANCA group (P < 0.001). Extraglomerular vasculitis, present in 22.2%, and chronic vascular leslons Indicative of previous vasculitis, present in 11.9% of patients, correlated with systemic involvement. Concluslon: The evolution of the pathologic lesions of PR3-ANCA and MPO-ANCA-associated glomerutonephritis seems to be similar. Differences in histopathology could be explained by the observation that in patients with PR3-ANCA, kidney biopsy was performed soon after renal invotvement appeared, and focal active lesions were prevalent, whereas in patients with MPO-ANCA, kidney biopsy was done late in the course of the disease, and diffuse chronic sclerotic lesions predominated. Renai extraglomerular small vessel vasculitis appeared to be predictive of systemic involvement. | |
Deskriptorji | VASCULITIS GLOMERULONEPHRITIS ANTIBODIES, ANTINEUTROPHIL CYTOPLASMIC ANTIGEN-ANTIBODY COMPLEX GLOMERULOSCLEROSIS, FOCAL IMMUNOHISTOCHEMISTRY FLUOROIMMUNOASSAY TREATMENT OUTCOME |