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Xiao X, Ren H, Gao P, Yin D, Li C, Wang T, Gou S, Liu F, Qiu H. What is the prognosis of ANCA-associated glomerulonephritis with immune deposition? Ren Fail 2022; 44:1477-1485. [PMID: 36000886 PMCID: PMC9415612 DOI: 10.1080/0886022x.2022.2114368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives This study aimed to analyze histological and clinical characteristics of patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) showing renal involvement to investigate the associations between immune complexes (IC) and clinicopathological indicators, and explore the renal outcomes of AAV. Methods We retrospectively evaluated the histopathological features and clinical characteristics of 80 renal biopsies of patients with AAV with renal involvement. Renal morphology was classified into two (with and without the presence of IC and complement deposition). Endpoints included end-stage kidney disease (ESKD) and death. Results Compared with patients without IC, patients with immune deposition had lower complement C3 (0.80 ± 0.27 vs. 0.93 ± 0.20, p = 0.024), more severe hematuria [133 (46–299) vs. 33 (15–115), p = 0.001] but had milder chronic pathology, including chronic tubular atrophy (p = 0.03), chronic interstitial fibrosis (p = 0.049). Patients in the immune deposition group showed a tendency to have more severe crescent formation and less glomerulosclerosis, but the difference was not statistically significant. Endpoints such as death and ESKD were not significantly different between the two groups. Conclusions Immune deposition may indicate lower complement C3, more severe hematuria and glomerular lesions, milder tubular atrophy, and interstitial fibrosis, but it cannot predict the renal outcome.
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Affiliation(s)
- Xiang Xiao
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China.,Department of Nephrology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Honghong Ren
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Peijuan Gao
- Department of Nephrology, Gansu Provincial Hospital, Lanzhou, China
| | - Dan Yin
- Bioinformatics under Biology Department, University of California-San Diego, San Diego, CA, USA
| | - Chao Li
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Tingli Wang
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Shenju Gou
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Fang Liu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongyu Qiu
- Department of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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2
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Yan J, Wang D, Zhao J, Zhou M, Huang B, Xing Y, Guo WF, Sun S. Clinical characteristics and prognostic value of renal immune complex deposition in patients with light chain amyloidosis. Front Oncol 2022; 12:949702. [PMID: 36313726 PMCID: PMC9608106 DOI: 10.3389/fonc.2022.949702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/22/2022] [Indexed: 07/28/2023] Open
Abstract
Although patients with light chain amyloidosis (AL) may present with co-deposition of amyloid and immune complexes (ICs) in renal biopsies, data on clinical characteristics and prognostic value of renal IC deposition are limited. A total of 73 patients with AL amyloidosis who were newly diagnosed by renal biopsy in Xijing Hospital (Xi'an, China) were divided into two groups (IC and non-IC groups). As a result, renal IC deposition was found in 26% of patients. Patients with IC deposition were associated with more urinary protein excretion and lower serum albumin. Notably, patients in the non-IC group achieved higher hematological overall response rate (81.5% vs. 47.4%, p = 0.007) and ≥VGPR rate (75.9% vs. 39.8%, p = 0.004) compared with those in IC group. Renal response rate was also higher in the non-IC group (63% vs. 31.6%, p = 0.031). With the median follow-up time of 19 months, a significantly worse overall survival was observed in patients with the IC group as compared with those without renal IC deposition in the Kaplan-Meier analysis (p = 0.036). Further multivariate analysis demonstrated that renal immune complex deposition was associated with worse overall survival in patients with AL amyloidosis (HR 5.927, 95% CI 2.148-16.356, p = 0.001).
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Affiliation(s)
- Jipeng Yan
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Di Wang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Meilan Zhou
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Boyong Huang
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Yan Xing
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Wei-Feng Guo
- School of Electrical Engineering, Zhengzhou University, Zhengzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shiren Sun
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
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Yang N, Zhao Y, Wu X, Zhang N, Song H, Wei W, Liu ML. Recent advances in Extracellular Vesicles and their involvements in vasculitis. Free Radic Biol Med 2021; 171:203-218. [PMID: 33951487 PMCID: PMC9107955 DOI: 10.1016/j.freeradbiomed.2021.04.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/08/2023]
Abstract
Systemic vasculitis is a heterogeneous group of multisystem autoimmune disorders characterized by inflammation of blood vessels. Although many progresses in diagnosis and immunotherapies have been achieved over the past decades, there are still many unanswered questions about vasculitis from pathological understanding to more advanced therapies. Extracellular vesicles (EVs) are double-layer phospholipid membrane vesicles harboring various cargoes. EVs can be classified into exosomes, microvesicles (MVs), and apoptotic bodies depending on their size and origin of cellular compartment. EVs can be released by almost all cell types and may be involved in physical and pathological processes including inflammation and autoimmune responses. In systemic vasculitis, EVs may have pathogenic involvement in inflammation, autoimmune responses, thrombosis, endothelium injury, angiogenesis and intimal hyperplasia. EV-associated redox reaction may also be involved in vasculitis pathogenesis by inducing inflammation, endothelial injury and thrombosis. Additionally, EVs may serve as specific biomarkers for diagnosis or monitoring of disease activity and therapeutic efficacy, i.e. AAV-associated renal involvement. In this review, we have discussed the recent advances of EVs, especially their roles in pathogenesis and clinical involvements in vasculitis.
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Affiliation(s)
- Nan Yang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300052, PR China
| | - Yin Zhao
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300052, PR China
| | - Xiuhua Wu
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300052, PR China
| | - Na Zhang
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300052, PR China
| | - Haoming Song
- Department of Cardiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, PR China
| | - Wei Wei
- Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Ming-Lin Liu
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Corporal Michael J. Crescenz VA Medical Center (Philadelphia), Philadelphia, PA, 19104, USA.
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Establishment and evaluation of a general dissociation technique for antibodies in circulating immune complexes. Clin Exp Med 2018; 19:65-75. [PMID: 30120614 PMCID: PMC6394588 DOI: 10.1007/s10238-018-0523-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 11/06/2022]
Abstract
This study aimed to establish a general and efficient dissociation technique for detecting antibodies in circulating immune complexes (CICs) in serum and to evaluate its clinical application. CICs were efficiently separated from specimens using polyethylene glycol double-precipitation. The best conditions for anti-HBs dissociation from HBsAg-ICs were a pH of 1.80, incubation at 15 °C for 5–10 min, and detection within 10 min after neutralization. The mean dissociation rate, reproducibility, mean dissociation recovery rate and specificity of the new technique were 64.3%, < 5.97, 95.4 and 100%, respectively. They had a favourable linear relationship (r = 0.9932), and the stability of the reagents exceeded 24 months, except the CIC antibody dissociation reagent (> 12 months). Conditions for the dissociation of other CICs tested were similar, but there were differences in the rate of antibody dissociation. Different HBV-M patterns had significantly different levels and rates of antibody dissociation from HBsAg-IC (P < 0.05), and the detection rates of the corresponding antibodies in HCV, core-anti-HCV core antibody (HCV-ICs), HIV P24-anti-HIV P24 antibody (HIV-ICs), insulin-anti-insulin antibody (INS-ICs) and thyroid globulin-anti-thyroid globulin antibody CICs (TG-ICs) were 34.8, 66.7, 20 and 14.3%, respectively. These data suggest that our CIC antibody dissociation technique is a good general pretreatment technique for the detection of antibodies after the precipitation, separation and dissociation of multiple CICs.
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Liang H, Xin M, Zhao L, Wang L, Sun M, Wang J. Serum creatinine level and ESR values associated to clinical pathology types and prognosis of patients with renal injury caused by ANCA-associated vasculitis. Exp Ther Med 2017; 14:6059-6063. [PMID: 29285157 PMCID: PMC5740565 DOI: 10.3892/etm.2017.5306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/05/2017] [Indexed: 01/16/2023] Open
Abstract
The correlation between serum creatinine and erythrocyte sedimentation rate (ESR) values and clinical pathology and prognosis in patients with renal injury caused by anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis were analyzed. Eighty-six patients with ANCA-associated vasculitis (AAV) treated in the Affiliated Hospital of Qingdao University were enrolled in the study. Patients were assigned into an elderly group (n=45) or a non-elderly group (n=41) according to age. The serum creatinine (Scr) level was measured via the sarcosine oxidase method, and the erythrocyte sedimentation rate (ESR) was measured using the full-automatic ESR analyzer; the relationship between Scr and ESR values and the pathology type of patients was statistically analyzed. The mean levels of Scr and ESR in the 86 patients were 406.87±12.37 µmol/l and 83.83±7.64 mm/1 h, respectively. Importantly, the levels of Scr and the ESR in the elderly group were significantly higher than those in the non-elderly group (P<0.05). In addition, patients with high levels of Scr and accelerated ESR presented mainly the crescentic and sclerotic pathological types, while in the same patients the numbers of focal and mixed types were lower (P<0.05). Kaplan-Meier analysis showed that the survival rate in the elderly group was significantly lower than that in the non-elderly group, and likewise patients with high levels of Scr and accelerated ESR had significantly lower survival rates than those with low levels of Scr and normal ESR (P<0.05). The AUC of the Scr level was 0.901, the sensitivity 90.2%, the specificity 89.5% and the cut-off value was 392.5 µmol/l; while the AUC of the ESR level was 0.864, the sensitivity 89.2%, the specificity 88.5% and the cut-off value 72.8 mm/1 h. Logistic regression analysis showed that the levels of Scr (OR=2.315, P<0.01) and ESR (OR=1.847, P<0.01) were independent factors affecting the prognosis of patients. Based on our findings, the seric Scr level and the ESR are closely related to the clinicopathological features of the disease in patients with renal injury caused by ANCA-associated vasculitis, and they can be used as prognosis and treatment evaluation markers.
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Affiliation(s)
- Hongda Liang
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
| | - Miaomiao Xin
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
| | - Lei Zhao
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
| | - Liqin Wang
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
| | - Mingshu Sun
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
| | - Jibo Wang
- Department of Rheumatology and Clinical Immunology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266005, P.R. China
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Dai Y, Hu Z, Chen Y, Lou B, Cui D, Xu A, Rao Y, He J, Yang J, Zeng X, Xu X, Wang G, Xu J, Zhou T, Sun C, Cheng J. A novel general and efficient technique for dissociating antigen in circulating immune complexes. Electrophoresis 2017; 39:406-416. [PMID: 28972666 DOI: 10.1002/elps.201700246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 02/05/2023]
Abstract
Circulating immune complexes (CICs) are produced during the immune response. It is more clinically important to establish a general and efficient CICs dissociation technique for the detection of antigens for CICs other than the detection of free antigens in the serum. Polyethylene glycol (PEG) two-precipitation separation and glycine-HCl as a buffer system were employed to develop a general and efficient buffer dissociation technique to separate CICs from serum and dissociate antigens from CICs. The measurement value of new PEG two-precipitation separation technique was higher than traditional PEG precipitation separation technique. There were slight differences in the dissociation conditions of HCV Core-IC, HIV P24-IC, Ins-IC and TG-IC as compared to HBsAg-IC. The detection of antigens in HBsAg-IC, HCV Core-IC, HIV P24-IC, Ins-IC and TG-IC with this technique was superior to that with HCl Dissociation, Trypsin Digestion or Immune Complex Transfer technique. PEG two-precipitation dissociation technique may reduce macromolecular protein and the adhesion of free antigens during the co-precipitation, which increases the efficiency of separation and precipitation of CICs. This technique also avoids the damage of reagents to antigens, assuring the repeatability, reliability and validity. Thus, this technique is application in samples negative or positive for free antigens.
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Affiliation(s)
- Yuzhu Dai
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China
| | - Zhengjun Hu
- Department of Clinical Laboratory, First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, P. R. China
| | - Yu Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Bin Lou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Dawei Cui
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Aifang Xu
- Department of Clinical Laboratory Science, Hangzhou Xixi Hospital, Hangzhou, P. R. China
| | - Yueli Rao
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China
| | - Jiahui He
- Department of Clinical Laboratory Science, Hangzhou Xixi Hospital, Hangzhou, P. R. China
| | - Jiezuan Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, P. R. China
| | - Xianming Zeng
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China
| | - Xujian Xu
- Department of Biotechnology, The University of Tokyo, Tokyo, Japan
| | - Guozheng Wang
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China
| | - Jian Xu
- Medical Technology College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, P. R. China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, P. R. China
| | - Changgui Sun
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China
| | - Jun Cheng
- Department of Clinical Laboratory, The 117th Hospital of PLA, Hangzhou, P. R. China.,Medical Technology College, Zhejiang University of Traditional Chinese Medicine, Hangzhou, P. R. China.,Faculty of Graduate Studies, Wenzhou Medical University, Wenzhou, P. R. China
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7
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Moinuddin I, Madhrira M, Bracamonte E, Thajudeen B, Sussman A. Membranous nephropathy with crescents associated with levamisole-induced MPO-ANCA vasculitis. Pathol Res Pract 2016; 212:650-3. [PMID: 27067665 DOI: 10.1016/j.prp.2016.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 02/16/2016] [Accepted: 03/18/2016] [Indexed: 11/24/2022]
Abstract
ANCA-associated vasculitis (AAV) is the most common cause of crescentic rapidly progressive glomerulonephritis (GN). Levamisole used as an adulterant in cocaine is increasingly recognized as a cause of AAV. We report the case of a 50 year old woman with atypical anti-MPO AAV associated with cocaine use and exposure to levamisole. In addition to the clinical and pathologic findings of crescentic GN, the patient also had biopsy evidence of secondary membranous nephropathy (MN). Although AAV and MN have been reported previously in the same patient and both have been induced by drug exposures, this is the first report of MN in a patient with AAV likely induced by levamisole. We suggest that MPO can cause both pauci-immune vasculitis and secondary membranous nephropathy in some cases, as in cases of levamisole-adulterated cocaine use.
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Affiliation(s)
- Irfan Moinuddin
- Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States.
| | - Machaiah Madhrira
- Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States.
| | - Erika Bracamonte
- Department of Pathology, University of Arizona Medical Center, Tucson, AZ, United States.
| | - Bijin Thajudeen
- Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States.
| | - Amy Sussman
- Division of Nephrology, University of Arizona Medical Center, Tucson, AZ, United States.
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