Zhang Qiong, Zhou Fei, Zhao Yan, Luo Congjuan, Luo Yankun, Zhou Yun
Department of Nephrology, Fifth Hospital of Shanxi Medical University (Shanxi Provincial People's Hospital), Taiyuan, China.
Shanxi Genetic Engineering Center for Experimental Animal Models, Taiyuan, China.
J Nephrol. 2024 Nov;37(8):2191-2200. doi: 10.1007/s40620-024-02085-5. Epub 2024 Oct 10.
The precise role of anti-neutrophil cytoplasmic antibodies (ANCAs) in the pathologic course of crescentic lupus nephritis (LN) remains unclear. Our study aimed to assess whether ANCA-positive serology in patients with LN and crescents is associated with different clinicopathologic features and outcomes.
We reviewed the records of 658 patients diagnosed with LN between 2010 and 2022. Among them, 64 (9.7%) patients who had complete follow-up and clinical data were reclassified as crescentic glomerulonephritis. Of these, 11 patients with incomplete ANCA data and 7 patients with less than 10 glomeruli under light microscopy were excluded; ultimately, 46 patients were enrolled: 12 with ANCA positivity and 34 with ANCA negativity. Clinicopathological characteristics and outcomes were analysed and compared.
Our data did not reveal any differences in clinical or laboratory parameters or histopathological features except for a significantly higher level of proteinuria or proportion of nephrotic syndrome (p < 0.05) at presentation before biopsy in the ANCA-negative group than in the ANCA-positive group,and a lower level of serum albumin (p < 0.05) in the ANCA-negative group than in the ANCA-positive group. No significant differences in complete remission or partial response were detected between the two groups based on the 2021 KDIGO criterion.
Short-term follow-up (average follow-up time of less than 3 years) did not reveal any difference in outcomes between ANCA-positive and ANCA-negative crescentic LN. However, the role of ANCAs in the pathological course of crescentic lupus nephropathy and the effect of ANCAs on long-term outcomes remain to be determined.
抗中性粒细胞胞浆抗体（ANCA）在新月体性狼疮性肾炎（LN）病理过程中的确切作用尚不清楚。我们的研究旨在评估LN合并新月体患者的ANCA阳性血清学是否与不同的临床病理特征及预后相关。
我们回顾了2010年至2022年间诊断为LN的658例患者的记录。其中，64例（9.7%）有完整随访和临床资料的患者被重新分类为新月体性肾小球肾炎。其中，11例ANCA数据不完整的患者和7例光镜下肾小球少于10个的患者被排除；最终纳入46例患者：12例ANCA阳性，34例ANCA阴性。对临床病理特征及预后进行分析和比较。
我们的数据显示，除了在活检前就诊时，ANCA阴性组的蛋白尿水平或肾病综合征比例显著高于ANCA阳性组（p<0.05），且ANCA阴性组的血清白蛋白水平低于ANCA阳性组（p<0.05）外，临床或实验室参数以及组织病理学特征均无差异。根据2021年KDIGO标准，两组之间在完全缓解或部分缓解方面未检测到显著差异。
短期随访（平均随访时间少于3年）未显示ANCA阳性和ANCA阴性新月体性LN在预后方面有任何差异。然而，ANCA在新月体性狼疮性肾病病理过程中的作用以及ANCA对长期预后的影响仍有待确定。
