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Supervised Machine Learning for Semi-Quantification of Extracellular DNA in Glomerulonephritis
Published on: June 18, 2020
Distinction between MPO-ANCA and PR3-ANCA-associated glomerulonephritis in Chinese patients: a retrospective
Yan Hong1,2, Pengxian Shi1, Xia Liu3
1Jinling Clinical Medical College of Nanjing Medical University, Nanjing, China.
Objectives:
To retrospectively investigate the clinical and histological features and outcomes of ANCA-associated glomerulonephritis (AAGN) with different ANCA serotypes.
Method:
A total of 467 AAGN patients were divided into MPO-AAGN (MPO) and PR3-AAGN (PR3) groups according to ANCA serotype. Clinical and histological features and renal outcomes were compared.
Results:
In this study, 429 (91.9%) patients tested positive for MPO-ANCA, and 38 (8.1%) for PR3-ANCA. The median age at diagnosis (P = 0.017) and proportion of females (P = 0.003) were higher in the MPO group. Joint (P < 0.001), ENT (P = 0.000), skin (P = 0.007), and eye (P = 0.014) involvements were more common in the PR3 group. Compared with that in the PR3-group, a higher proportion of patients in the MPO group had microscopic polyangiitis (P = 0.000), and a lower proportion of exhibited granulomatosis with polyangiitis (P = 0.000). Patients in the MPO group also exhibited lower BVAS scores (P = 0.003) and higher serum albumin levels (P = 0.009). Histologically, a lower proportion of MPO patients had crescentic glomerulonephritis (P = 0.028) and acute tubule-interstitial lesion scores (P = 0.007), but a higher proportion of these patients exhibited mixed class glomerulonephritis (P = 0.032) than in the PR3 group. The relapse rate was lower (P = 0.020), and the 5-year relapse-free survival rate (P = 0.003) was higher in the MPO group than in the PR3 group. However, the 5-year renal survival rates (P = 0.106) were not significantly different.
Conclusions:
MPO-ANCA was predominant in Chinese patients with ANCA-associated vasculitis and renal disease. The epidemiological characteristics, extra-renal involvement, and histopathological classes and outcomes were different between MPO-positive and PR3-positive patients, implying that they might be two different disease entities.
Insights
MPO-ANCA is more common than PR3-ANCA in Chinese patients with ANCA-associated glomerulonephritis. These serotypes present with distinct clinical, histological, and outcome differences, suggesting they may represent separate disease entities.
Area of Science:
- Nephrology
- Immunology
- Rheumatology
Background:
- ANCA-associated glomerulonephritis (AAGN) is a severe autoimmune condition.
- Distinguishing between MPO-ANCA and PR3-ANCA is crucial for understanding disease heterogeneity.
Purpose of the Study:
- To compare clinical, histological, and outcome differences between MPO-ANCA and PR3-ANCA in AAGN patients.
- To investigate if MPO-ANCA and PR3-ANCA represent distinct disease entities.
Main Methods:
- Retrospective analysis of 467 AAGN patients.
- Classification into MPO-AAGN and PR3-AAGN groups based on ANCA serotype.
- Comparison of clinical, histological, and renal outcomes between groups.
Main Results:
- MPO-ANCA (91.9%) was predominant over PR3-ANCA (8.1%).
- MPO-AAGN patients were older, had a higher proportion of females, and showed less extra-renal involvement (joint, ENT, skin, eye) compared to PR3-AAGN.
- MPO-AAGN had lower BVAS scores, higher serum albumin, less crescentic glomerulonephritis, and better relapse-free survival but similar renal survival rates compared to PR3-AAGN.
Conclusions:
- MPO-ANCA is the dominant serotype in Chinese AAGN patients.
- Significant differences in epidemiology, extra-renal manifestations, histopathology, and outcomes exist between MPO-ANCA and PR3-ANCA.
- These findings support the classification of MPO-ANCA and PR3-ANCA as distinct disease entities.
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