Clinical and Immunologic Characteristics of Patients With ANCA-Associated Glomerulonephritis Combined With Membranous Nephropathy: A Retrospective Cohort Study in a Single Chinese Center

Medicine (Baltimore). 2015 Sep;94(37):e1472. doi: 10.1097/MD.0000000000001472.

Abstract

The concurrent antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN) and membranous nephropathy (MN) have been increasingly documented, mainly in case studies and case series; however, the differences of clinical and pathologic characteristics as well as outcomes between ANCA-GN patients with and without MN remain unclear. The current study investigated the clinical and immunologic features of patients with combined ANCA-GN and MN in a large cohort. Twenty-seven of 223 patients had combined ANCA-GN and MN; they had significantly higher levels of initial serum creatinine, higher Birmingham Vasculitis Activity Score and poorer renal outcome than ANCA-GN patients without MN (P < 0.05). ANCA-GN patients with MN could recognize the light chain of myeloperoxidase more frequently than those without MN (P < 0.05). The prevalence of circulating anti-PLA2R antibodies and glomerular PLA2R deposits was significantly lower in patients with combined ANCA-GN and MN than that in patients with idiopathic MN (P < 0.05). Compared with the idiopathic MN patients, the patients with combined ANCA-GN and MN had significantly higher recognition frequency of immunoglobulin (Ig) G2 and IgG3, and significantly lower recognition frequency of IgG4 (P < 0.05). Patients with combined ANCA-GN and MN had distinct clinical features and a different pathogenesis of MN.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antibodies, Antineutrophil Cytoplasmic / blood*
  • China / epidemiology
  • Female
  • Glomerulonephritis, Membranous / immunology*
  • Glomerulonephritis, Membranous / mortality
  • Glomerulonephritis, Membranous / pathology
  • Humans
  • Immunoglobulin G / metabolism
  • Kidney / immunology
  • Kidney / metabolism
  • Kidney / pathology
  • Male
  • Middle Aged
  • Peroxidase / immunology
  • Receptors, Phospholipase A2 / immunology
  • Receptors, Phospholipase A2 / metabolism

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Immunoglobulin G
  • Receptors, Phospholipase A2
  • Peroxidase