Back to Search
Start Over
Interstitial Immunostaining and Renal Outcomes in Antineutrophil Cytoplasmic Antibody-Associated Glomerulonephritis.
- Source :
-
American journal of nephrology [Am J Nephrol] 2017; Vol. 46 (3), pp. 231-238. Date of Electronic Publication: 2017 Sep 08. - Publication Year :
- 2017
-
Abstract
- Background: Immunopathologic features predict renal function at baseline and follow-up in antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN). The interstitial infiltrate consists predominantly of T lymphocytes, but their pathophysiologic significance is unclear, especially in light of the success of B-cell-directed therapy.<br />Methods: Renal biopsies from 33 patients treated with cyclophosphamide (CYC; n = 17) or rituximab (RTX; n = 16) in the RTX in ANCA-associated vasculitis (RAVE) trial were classified according to the new ANCA GN classification. T- and B-cell infiltration in the interstitium was assessed by immunostaining for CD3 and CD20. Correlations of clinical and histologic parameters with renal function at set time points were examined.<br />Results: The mean (SD) baseline estimated glomerular filtration rate was 36 (20) mL/min/1.73 m2. ANCA GN class distribution was 46% focal, 33% mixed, 12% sclerotic and 9% crescentic. The interstitial infiltrate consisted of >50% CD3 positive cells in 69% of biopsies, but >50% CD20 positive cells only in 8% of biopsies. In a multiple linear regression model, only baseline glomerular filtration rate (GFR) correlated with GFR at 6, 12, and 18 months. Interstitial B- and T-cell infiltrates had no significant impact on long-term prognosis, independent of the treatment limb. A differential effect was noted only at 6 months, where a dense CD3 positive infiltrate predicted lower GFR in the RTX group and a CD20 positive infiltrate predicted higher GFR in the CYC group.<br />Conclusions: In ANCA-associated GN, the interstitial infiltrate contains mainly T lymphocytes. However, it is neither reflecting baseline renal function nor predictive of response to treatment, regardless of the immunosuppression regimen employed.<br /> (© 2017 S. Karger AG, Basel.)
- Subjects :
- Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis blood
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis immunology
Antibodies, Antineutrophil Cytoplasmic blood
Antigens, CD20 analysis
B-Lymphocytes immunology
Biopsy
CD3 Complex analysis
Cyclophosphamide therapeutic use
Female
Follow-Up Studies
Glomerular Filtration Rate
Glomerulonephritis blood
Glomerulonephritis drug therapy
Glomerulonephritis immunology
Humans
Kidney immunology
Male
Middle Aged
Prognosis
Rituximab therapeutic use
T-Lymphocytes immunology
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis pathology
Antibodies, Antineutrophil Cytoplasmic immunology
Glomerulonephritis pathology
Immunosuppressive Agents therapeutic use
Kidney pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1421-9670
- Volume :
- 46
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- American journal of nephrology
- Publication Type :
- Academic Journal
- Accession number :
- 28881339
- Full Text :
- https://doi.org/10.1159/000480443