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Kuang H, Jiang N, Jia XY, Cui Z, Zhao MH. Epidemiology, clinical features, risk factors, and outcomes in anti-glomerular basement membrane disease: A systematic review and meta-analysis. Autoimmun Rev 2024; 23:103531. [PMID: 38493958 DOI: 10.1016/j.autrev.2024.103531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 03/19/2024]
Abstract
Anti-glomerular basement membrane (GBM) disease is a small-vessel vasculitis that represents the most aggressive form of autoimmune glomerulonephritis. The study aimed to investigate the prevalence, clinical characteristics, risk factors, and outcomes of anti-GBM disease through a systematic review and meta-analysis involving 47 studies with 2830 patients. The overall incidence of anti-GBM disease ranged from 0.60 to 1.79 per million population per annum. In rapidly progressive glomerulonephritis and crescentic glomerulonephritis, the pooled incidence rates were 8.0% and 12.8%, respectively. The pooled prevalence rates of anti-GBM antibodies, antineutrophil cytoplasmic antibodies (ANCA), and lung hemorrhage were 88.8%, 27.4%, and 32.6%, respectively. Patients with combined ANCA positivity demonstrated a prognosis comparable to those patients with only anti-GBM antibodies, though with differing clinical features. The pooled one-year patient and kidney survival rates were 76.2% and 30.2%, respectively. Kidney function on diagnosis and normal glomeruli percentage were identified as strong prognostic factors. This study represents the first comprehensive meta-analysis on anti-GBM disease, providing insights into its management. However, caution is warranted in interpreting some results due to the observational nature of the included studies and high heterogeneity.
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Affiliation(s)
- Huang Kuang
- Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Nan Jiang
- Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Yu Jia
- Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Zhao Cui
- Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming-Hui Zhao
- Renal Division, Peking University First Hospital, Beijing, China; Institute of Nephrology, Peking University, Beijing, China; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Kumar A, Gupta S, Jarial KDS, Sangha S, Chauhan A, Sharma V, Sandal R, Sharma D. Clinical Profile and Renal Survival of Anti-Glomerular Basement Membrane Disease Patients: A Retrospective Case Series from Northern India. GLOMERULAR DISEASES 2023; 3:241-247. [PMID: 38021463 PMCID: PMC10645438 DOI: 10.1159/000534498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Abstract
Introduction Anti-glomerular basement membrane (anti-GBM) disease is a rare organ-specific autoimmune disease. The overall and renal outcomes of patients have mostly been reported in small-sized cohorts. We aimed to study the clinical profile, overall survival, and renal survival of anti-glomerular basement membrane disease patients at our center. Methods We conducted a retrospective analysis of the data regarding the clinical profile and renal survival of patients diagnosed with anti-GBM disease from October 2019 to March 2022, having a minimum follow-up of 12 months. Results There were 15 patients in the study, with the mean age of presentation being 51.6 ± 13.7 years. The median duration of symptoms onset to the nephrologist opinion was 15 (10-23) days. The extrarenal manifestations were seen in the respiratory, otorhinolaryngological, and neurological systems. The mean serum anti-GBM titers were 154.5 (14.9-263.5) U/mL. Serum anti-GBM titers were present in 13/15 (86.6%) patients, and 12/13 (92.3%) patients had above the reference range. Anti-neutrophil cytoplasm antibody (ANCA) levels were assessed in 12/15 (80%) patients, and 9/12 (75%) had higher levels. Renal biopsy was available in 14 patients with more than 50% crescents. Along with crescents, necrotizing lesions, rupture of the Bowman's capsule, and granulomatous lesions were also seen. Among the initial therapies, the steroid pulse was given to 13 (86.6%) patients, whereas membrane plasmapheresis was given to 8 (53.3%) patients. Inj. cyclophosphamide and inj. rituximab were given to 8 (53.3%) and 4 (26.6%) patients, respectively. No difference was seen in clinical characteristics, renal biopsy features, treatment received, and outcomes with ANCA positivity except for age, where patients who were ANCA positive were older compared to patients who were ANCA negative. One-year renal and patient survival was seen in 4 (26.6%) and 6 (40%) patients, respectively. Conclusion Most patients of anti-GBM disease have active sediments, raised creatinine, and non-specific symptomatology. There is poor renal and patient outcome as most patients present with advanced renal failure.
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Affiliation(s)
- Asheesh Kumar
- Department of Nephrology, All India Institute of Medical Sciences, Vijaypur, India
| | - Samriti Gupta
- Department of Paediatrics, All India Institute of Medical Sciences, Vijaypur, India
| | - Kush Dev Singh Jarial
- Department of Endocrinology, All India Institute of Medical Sciences, Vijaypur, India
| | | | - Ashish Chauhan
- Department of Gastroenterology and Human Nutrition, Indira Gandhi Medical College and Hospital Shimla, Shimla, India
| | - Vikas Sharma
- Department of Medicine, Indira Gandhi Medical College and Hospital Shimla, Shimla, India
| | - Rajeev Sandal
- Department of Radiotherapy, Indira Gandhi Medical College and Hospital Shimla, Shimla, India
| | - Dheeraj Sharma
- Department of Emergency Medicine, Indira Gandhi Medical College and Hospital Shimla, Shimla, India
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Gupta A, Agrawal V, Kaul A, Verma R, Jain M, Prasad N, Pandey R. Etiological Spectrum and Clinical Features in 215 Patients of Crescentic Glomerulonephritis: Is it Different in India? Indian J Nephrol 2021; 31:157-162. [PMID: 34267438 PMCID: PMC8240944 DOI: 10.4103/ijn.ijn_237_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/29/2019] [Accepted: 11/10/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Crescentic glomerulonephritis (CrGN) characterized by the presence of crescents in most (≥50%) glomeruli on renal histology clinically presents as rapidly progressive renal failure. It can occur due to diverse etiologies with varying course and renal outcomes. We studied the prognostic significance of its classification as pauci-immune, anti-GBM, and immune-complex mediated CrGN. MATERIALS AND METHODS Renal biopsies diagnosed as CrGN over 9 years were included. Clinical, biochemical, serological, and histological features of various classes of CrGN were correlated with renal outcome. RESULTS 215 biopsies were diagnosed as CrGN during this period. A majority (63%) were immune-complex mediated while 32% were pauci-immune, followed by anti-GBM disease (5%). 85.5% of pauci-immune CrGN were ANCA associated. The levels of proteinuria and serum creatinine were significantly higher in anti-GBM CrGN as compared to the other two classes. The various histological features including Bowman's capsule rupture, peri-glomerular granulomatous reaction, fibrinoid necrosis, and vasculitis were more common in anti-GBM disease and pauci-immune CrGN. The median renal survival was 6.3, 5.3, 2.1 months in immune-complex mediated, pauci-immune, and anti-GBM CrGN, respectively. CONCLUSION Immune-complex mediated is the commonest etiology of CrGN in India. Anti-GBM disease has the worst prognosis followed by pauci-immune and immune-complex mediated CrGN. Raised serum creatinine levels (>5mg%) and the degree of glomerulosclerosis at diagnosis were predictors of poor renal survival. High index of suspicion and prompt diagnosis can improve the outcome in these patients.
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Affiliation(s)
- Anubha Gupta
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Anupma Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Ritu Verma
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Rakesh Pandey
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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