医学
内科学
肾病科
回顾性队列研究
显微镜下多血管炎
胃肠病学
肾炎
肾活检
抗中性粒细胞胞浆抗体
狼疮性肾炎
病理
血管炎
活检
作者
Takeshi Zoshima,Kazuyuki Suzuki,Fae Suzuki,Satoshi Hara,Keishi Mizuguchi,Kiyoaki Ito,Ichiro Mizushima,Hiroshi Fujii,Hideki Nomura,Mitsuhiro Kawano
标识
DOI:10.1007/s10157-020-01925-5
摘要
Although crescentic glomerulonephritis is a hallmark of ANCA-associated nephritis, the clinicopathological features of ANCA-associated nephritis without crescent formation remain to be elucidated. We enrolled 146 Japanese ANCA-associated vasculitis (AAV) patients subjected to renal biopsy in 16 hospitals from 2001 to 2018, and compared those with and without crescent formation (C + and C− groups). The primary endpoint was end-stage renal disease (ESRD) and/or death. C− group comprised 25 (17.1%) subjects. They had better renal function at the time of renal biopsy [estimated glomerular filtration rate (eGFR); median 41.7 vs 27.5 ml/min/1.73 m2, p < 0.01] with minor urinary abnormalities but had a higher serum C-reactive protein level (8.8 vs 5.4 mg/dl, p = 0.01) and frequency of extra-renal lesions of AAV (76.0% vs 48.8%, p = 0.02) than C + group. Pathologically, C− group had a higher frequency of arteritis (40.0% vs 16.5%, p < 0.01). Kaplan–Meier method with log-rank tests showed no significant difference in renal and life prognosis combined, regardless of crescent formation. Multivariate Cox regression analysis revealed baseline eGFR, sclerotic class, and extra-renal lesions to be risk factors of ESRD and death combined. Competing risk analysis showed baseline eGFR and sclerotic class to be associated with ESRD, whereas baseline eGFR and extra-renal lesions were associated with death. ANCA-associated nephritis without crescent formation had different clinicopathological features from those with crescent formation, suggesting an atypical subtype of ANCA-associated nephritis. Despite the better renal function at the time of renal biopsy, these results suggest that this subtype requires especially careful attention, especially in the presence of extra-renal involvement.
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