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Abstract: PO1946

Immunological Indexes Both in Renal and Serum Were Associated with Renal and Patient Outcome in Chinese Patients with Myeloperoxidase-ANCA-Associated Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Lin, Wei, Department of Nephrology, Xiangya Hospital, Central South University, China, Changsha, Hunan Province, China
  • Yong, Zhong, Department of Nephrology, Xiangya Hospital, Central South University, China, Changsha, Hunan Province, China
Background

Rapidly progressive glomerulonephritis (RPGN) caused by antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are typically characterized by few or no immune deposits in glomerulus which was defined as pauci-immune glomerulonephritis(GN). Immune complex (IC) deposits in glomerulus and abnormal serum immune indexes have also been reported in some studies. Most patients with AAV in China are positive for anti-myeloperoxidase (MPO), which more frequently had renal involvement and developed RPGN. Therefore, it is necessary to assess serum immunological indexes and the IC deposits in renal in MPO-ANCA-associated GN.

Methods

Clinical and histopathologic characteristics of 97 patients who had renal biopsy-proven as necrotizing and crescentic MPO-ANCA-GN from 2002 to 2019 were recruited in this study. Serum immunological indexes (sC3, sC4, sIgA, sIgG, sIgM), immune deposits in the kidney (C3, C4, IgA, IgG, IgM) in immunofluorescence (IF) at diagnosis were retrospectively analyzed.

Results

Patients with low sC3 (≤790 ml/L) and low sC4 (≤100 ml/L) at diagnosis showed poorer renal survival compared to patients with normal value (p=0.003, 0.011). Furthermore, among patients of low sC3 at diagnosis, the cases with persistent low sC3 showed an obviously worse renal survival than those whose sC3 recovered to normal after treatment (p<0.001).
There are 41%(40/97) patients showed positive IF findings (≥2+ on a 0 to 4+ scale) for at least one Ig or complement component. in our study. The patients with IC deposits showed higher level of serum creatinine (p=0.01) and lower platelet counts (p=0.009), sC3 level (p=0.013) than patients with pauci-IC deposition at diagnosis.
We also found IgG deposits related to worse renal outcome than the negtative cases (p=0.047). What's more, complement C1q deposits displayed significant poorer patient survival than the cases without C1q deposits (p=0.001).

Conclusion

Patients with a persistent low sC3 showed poorer renal prognosis than the patients whose sC3 level return to normal after a period of treatment, which was confirmed that both initial and continuously low sC3 can act as predictive indicators for renal outcome. IgG and complement C1q deposits associated with poorer renal and patient outcome, which can help to judge the prognosis of MPO-ANCA-associated GN to some extent.