Glomerular immune deposits are associated with increased proteinuria patients with ANCA-associated crescentic nephritis

I. Neumann, H. Regele, Renate Kain, R. Birck, F. T. Meisl

    Research output: Contribution to journalArticle

    63 Citations (Scopus)

    Abstract

    Background. In small vessel vasculitis and its renal-limited form, idiopathic crescentic glomerulonephritis, renal damage is characterized by pauci-immune necrotizing crescentic glomerulonephritis (CGN) without histological evidence of immunoglobulin (Ig) deposition. In some patients, however, significant amounts of immune deposits may be detected. Therefore, we evaluated the clinical significance of these immune deposits in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune CGN.

    Methods. Renal biopsies of 45 consecutive patients with new onset of Wegener's granulomatosis' microscopic polyangiitis and idiopathic CGN were retrospectively evaluated by light microscopy, immunohistochemistry and electron microscopy and the findings compared with renal function and outcome.

    Results. Typical pauci-immune CGN was found in 37 patients (group I). In eight patients (18%; group II), however, histopathological examination revealed substantial deposition of Ig in the mesangium and/or along the glomerular basement membrane. Five of these eight patients were cANCA positive; two initially had pANCA and developed a cANCA pattern and one was pANCA positive. There were no differences between groups in age, gender, renal function or extrarenal organ involvement at the time of biopsy. However, patients in group II had significantly more proteinuria (5.4+/-3.1 vs 1.3+/-1.0 g/24 h; P=0.016). We also observed a trend for a worse outcome with respect to renal function and mortality in group II patients; however, the differences did not reach significance.

    Conclusions. Our results confirm that in ANCA-associated CGN a substantial percentage of patients have evidence of Ig deposition in renal biopsies. In this subgroup, Ig deposition was associated with a significantly greater degree of proteinuria. Further investigations are necessary to define the full clinical impact of immune-complex deposition on the clinical course of renal disease in pauci-immune CGN.

    Original languageEnglish
    Pages (from-to)524-531
    Number of pages7
    JournalNephrology Dialysis Transplantation
    Volume18
    Issue number3
    DOIs
    Publication statusPublished - 2003

    Keywords

    • immune deposits
    • necrotizing crescentic glomerulonephritis
    • pauci-immune
    • renal histology
    • WEGENERS GRANULOMATOSIS
    • SYSTEMIC VASCULITIS
    • DISEASE-ACTIVITY
    • GLOMERULONEPHRITIS
    • MYELOPEROXIDASE
    • AUTOANTIBODIES
    • REMISSION

    Cite this

    Glomerular immune deposits are associated with increased proteinuria patients with ANCA-associated crescentic nephritis. / Neumann, I.; Regele, H.; Kain, Renate; Birck, R.; Meisl, F. T.

    In: Nephrology Dialysis Transplantation, Vol. 18, No. 3, 2003, p. 524-531.

    Research output: Contribution to journalArticle

    Neumann, I. ; Regele, H. ; Kain, Renate ; Birck, R. ; Meisl, F. T. / Glomerular immune deposits are associated with increased proteinuria patients with ANCA-associated crescentic nephritis. In: Nephrology Dialysis Transplantation. 2003 ; Vol. 18, No. 3. pp. 524-531.
    @article{27121874c08649b798b9ec7c2cde4b3b,
    title = "Glomerular immune deposits are associated with increased proteinuria patients with ANCA-associated crescentic nephritis",
    abstract = "Background. In small vessel vasculitis and its renal-limited form, idiopathic crescentic glomerulonephritis, renal damage is characterized by pauci-immune necrotizing crescentic glomerulonephritis (CGN) without histological evidence of immunoglobulin (Ig) deposition. In some patients, however, significant amounts of immune deposits may be detected. Therefore, we evaluated the clinical significance of these immune deposits in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune CGN.Methods. Renal biopsies of 45 consecutive patients with new onset of Wegener's granulomatosis' microscopic polyangiitis and idiopathic CGN were retrospectively evaluated by light microscopy, immunohistochemistry and electron microscopy and the findings compared with renal function and outcome.Results. Typical pauci-immune CGN was found in 37 patients (group I). In eight patients (18{\%}; group II), however, histopathological examination revealed substantial deposition of Ig in the mesangium and/or along the glomerular basement membrane. Five of these eight patients were cANCA positive; two initially had pANCA and developed a cANCA pattern and one was pANCA positive. There were no differences between groups in age, gender, renal function or extrarenal organ involvement at the time of biopsy. However, patients in group II had significantly more proteinuria (5.4+/-3.1 vs 1.3+/-1.0 g/24 h; P=0.016). We also observed a trend for a worse outcome with respect to renal function and mortality in group II patients; however, the differences did not reach significance.Conclusions. Our results confirm that in ANCA-associated CGN a substantial percentage of patients have evidence of Ig deposition in renal biopsies. In this subgroup, Ig deposition was associated with a significantly greater degree of proteinuria. Further investigations are necessary to define the full clinical impact of immune-complex deposition on the clinical course of renal disease in pauci-immune CGN.",
    keywords = "immune deposits, necrotizing crescentic glomerulonephritis, pauci-immune, renal histology, WEGENERS GRANULOMATOSIS, SYSTEMIC VASCULITIS, DISEASE-ACTIVITY, GLOMERULONEPHRITIS, MYELOPEROXIDASE, AUTOANTIBODIES, REMISSION",
    author = "I. Neumann and H. Regele and Renate Kain and R. Birck and Meisl, {F. T.}",
    year = "2003",
    doi = "10.1093/ndt/18.3.524",
    language = "English",
    volume = "18",
    pages = "524--531",
    journal = "Nephrology Dialysis Transplantation",
    issn = "0931-0509",
    publisher = "OXFORD UNIV PRESS",
    number = "3",

    }

    TY - JOUR

    T1 - Glomerular immune deposits are associated with increased proteinuria patients with ANCA-associated crescentic nephritis

    AU - Neumann, I.

    AU - Regele, H.

    AU - Kain, Renate

    AU - Birck, R.

    AU - Meisl, F. T.

    PY - 2003

    Y1 - 2003

    N2 - Background. In small vessel vasculitis and its renal-limited form, idiopathic crescentic glomerulonephritis, renal damage is characterized by pauci-immune necrotizing crescentic glomerulonephritis (CGN) without histological evidence of immunoglobulin (Ig) deposition. In some patients, however, significant amounts of immune deposits may be detected. Therefore, we evaluated the clinical significance of these immune deposits in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune CGN.Methods. Renal biopsies of 45 consecutive patients with new onset of Wegener's granulomatosis' microscopic polyangiitis and idiopathic CGN were retrospectively evaluated by light microscopy, immunohistochemistry and electron microscopy and the findings compared with renal function and outcome.Results. Typical pauci-immune CGN was found in 37 patients (group I). In eight patients (18%; group II), however, histopathological examination revealed substantial deposition of Ig in the mesangium and/or along the glomerular basement membrane. Five of these eight patients were cANCA positive; two initially had pANCA and developed a cANCA pattern and one was pANCA positive. There were no differences between groups in age, gender, renal function or extrarenal organ involvement at the time of biopsy. However, patients in group II had significantly more proteinuria (5.4+/-3.1 vs 1.3+/-1.0 g/24 h; P=0.016). We also observed a trend for a worse outcome with respect to renal function and mortality in group II patients; however, the differences did not reach significance.Conclusions. Our results confirm that in ANCA-associated CGN a substantial percentage of patients have evidence of Ig deposition in renal biopsies. In this subgroup, Ig deposition was associated with a significantly greater degree of proteinuria. Further investigations are necessary to define the full clinical impact of immune-complex deposition on the clinical course of renal disease in pauci-immune CGN.

    AB - Background. In small vessel vasculitis and its renal-limited form, idiopathic crescentic glomerulonephritis, renal damage is characterized by pauci-immune necrotizing crescentic glomerulonephritis (CGN) without histological evidence of immunoglobulin (Ig) deposition. In some patients, however, significant amounts of immune deposits may be detected. Therefore, we evaluated the clinical significance of these immune deposits in anti-neutrophil cytoplasmic autoantibody (ANCA)-associated pauci-immune CGN.Methods. Renal biopsies of 45 consecutive patients with new onset of Wegener's granulomatosis' microscopic polyangiitis and idiopathic CGN were retrospectively evaluated by light microscopy, immunohistochemistry and electron microscopy and the findings compared with renal function and outcome.Results. Typical pauci-immune CGN was found in 37 patients (group I). In eight patients (18%; group II), however, histopathological examination revealed substantial deposition of Ig in the mesangium and/or along the glomerular basement membrane. Five of these eight patients were cANCA positive; two initially had pANCA and developed a cANCA pattern and one was pANCA positive. There were no differences between groups in age, gender, renal function or extrarenal organ involvement at the time of biopsy. However, patients in group II had significantly more proteinuria (5.4+/-3.1 vs 1.3+/-1.0 g/24 h; P=0.016). We also observed a trend for a worse outcome with respect to renal function and mortality in group II patients; however, the differences did not reach significance.Conclusions. Our results confirm that in ANCA-associated CGN a substantial percentage of patients have evidence of Ig deposition in renal biopsies. In this subgroup, Ig deposition was associated with a significantly greater degree of proteinuria. Further investigations are necessary to define the full clinical impact of immune-complex deposition on the clinical course of renal disease in pauci-immune CGN.

    KW - immune deposits

    KW - necrotizing crescentic glomerulonephritis

    KW - pauci-immune

    KW - renal histology

    KW - WEGENERS GRANULOMATOSIS

    KW - SYSTEMIC VASCULITIS

    KW - DISEASE-ACTIVITY

    KW - GLOMERULONEPHRITIS

    KW - MYELOPEROXIDASE

    KW - AUTOANTIBODIES

    KW - REMISSION

    U2 - 10.1093/ndt/18.3.524

    DO - 10.1093/ndt/18.3.524

    M3 - Article

    VL - 18

    SP - 524

    EP - 531

    JO - Nephrology Dialysis Transplantation

    JF - Nephrology Dialysis Transplantation

    SN - 0931-0509

    IS - 3

    ER -