title: Clinicopathologic Characteristics and Outcomes of Lupus Nephritis With Antineutrophil Cytoplasmic Antibody: A Retrospective Study.
abstract: Few studies have analyzed the clinicopathologic characteristics and outcomes of lupus nephritis (LN) patients with antineutrophil cytoplasmic antibody (ANCA). The clinical and renal histopathologic data of 154 patients with biopsy-proven LN from 2011 to 2013 were analyzed retrospectively. The patients were followed up for a median period of 16.8 ± 9.4 months, and their outcomes were analyzed. Multivariate Cox analysis was used to evaluate the independent factors for poor outcomes. Among the 154 LN patients, 26 (16.88%) were seropositive for ANCA. The incidences of alopecia, oral ulcer, photosensitivity and skin lesion, and psychosomatic manifestations in the ANCA-positive group were significantly higher than in the ANCA-negative group (P = 0.007, 0.02, 0.02, and 0.03, respectively). Compared with the ANCA-negative group, the ANCA-positive group had significantly lower levels of complement C3 (P = 0.03). Additionally, the positive rate of antinucleosome antibodies, antihistone antibodies, antimitochondrial antibody M2, and anticardiolipin antibodies were higher significantly in the ANCA-positive patients than in the ANCA-negative patients (P = 0.001, 0.001, 0.03, 0.005, respectively). The ANCA-positive group had a notably higher chronic index than the ANCA-negative group (P = 0.01). During the follow-up, the complete remission rate in the ANCA-negative group was higher than that in the ANCA-positive group (P = 0.01). The cumulative renal survival rate in the ANCA-positive group was significantly lower than in the ANCA-negative group (log-rank = 6.59, P = 0.01). Multivariate Cox analysis revealed that the reduced estimated glomerular filtration rate (HR, 1.02; 95% confidence interval, 1.01 to 1.03; P = 0.005), NLR (HR, 1.20; 95% confidence interval, 1.02 to 1.40; P = 0.03), and ANCA (HR, 3.37; 95% confidence interval, 1.12 to 10.09; P = 0.03) were independent risk factors for patients' renal survival after adjusting for age, sex, crescent formation, and glomerulosclerosis. The study found ANCA in LN patients is not rare, and patients with ANCA present with more severe clinicopathologic injuries. Thus, ANCA is an independent risk factor for poor renal outcomes in LN patients.
authors.affiliation: From the Department of Nephrology, Xinqiao Hospital (YW, XH, JC, LX, WW, ST, SY, XG, JZ, JZ, YH, YZ, JZ); and Department of Epidemiology in College of Preventive Medicine, Third Military Medical University, Chongqing, China (YL).
authors.forename: Yuan
authors.initials: Y
authors.lastname: Wang
authors.forename: Xin
authors.initials: X
authors.lastname: Huang
authors.forename: Juan
authors.initials: J
authors.lastname: Cai
authors.forename: Lijiao
authors.initials: L
authors.lastname: Xie
authors.forename: Weili
authors.initials: W
authors.lastname: Wang
authors.forename: Sha
authors.initials: S
authors.lastname: Tang
authors.forename: Shiwei
authors.initials: S
authors.lastname: Yin
authors.forename: Xuejing
authors.initials: X
authors.lastname: Gao
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Jinghong
authors.initials: J
authors.lastname: Zhao
authors.forename: Yunjian
authors.initials: Y
authors.lastname: Huang
authors.forename: Yafei
authors.initials: Y
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jingbo
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000505:Alopecia / Q000150:complications; D017153:Antibodies, Anticardiolipin / Q000097:blood; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood*; D003176:Complement C3 / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006657:Histones / Q000276:immunology; D006801:Humans; D008181:Lupus Nephritis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology*; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000276:immunology; D009504:Neutrophils; D009707:Nucleosomes / Q000276:immunology; D019226:Oral Ulcer / Q000150:complications; D010787:Photosensitivity Disorders / Q000150:complications; D011379:Prognosis; D011602:Psychophysiologic Disorders / Q000150:complications; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D017153:Antibodies, Anticardiolipin; D019268:Antibodies, Antineutrophil Cytoplasmic; D003176:Complement C3; D006657:Histones; D009707:Nucleosomes
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